Spectrum: Local Antimicrobial Stewardship, for CHEO-OCTC

Bacterial Endocarditis Prevention with Dental Procedures

Criteria for Prophylaxis

Indicated for dental procedures that involve manipulation of gingival tissue, manipulation of the periapical region of teeth, or perforation of the oral mucosa in patients with:

  1. Prosthetic cardiac valves, including transcatheter-implanted prostheses and homografts.
  2. Prosthetic material used for cardiac valve repair, such as annuloplasty rings and chords.
  3. Previous infective endocarditis.
  4. Unrepaired cyanotic congenital heart disease or repaired congenital heart disease, with residual shunts or valvular regurgitation at the site of or adjacent to the site of a prosthetic patch or prosthetic device.
  5. Cardiac transplant with valve regurgitation due to a structurally abnormal valve.

Suggested Regimen

Amoxicillin 50 mg/kg/dose x 1 (Max 2000mg)

OR

Ampicillin 50 mg/kg/dose x 1 (Max 2000mg)

OR

Cefazolin 50 mg/kg/dose x 1 (Max 1000mg)

OR

If severe (e.g. SJS, DRESS, TEN) prior reaction to ampicillin or cefazolin

Clindamycin PO/IV 20 mg/kg/dose x 1 (Max 600mg)

OR

Clarithromycin 15 mg/kg/dose x 1 (Max: 500mg)

NOTES:

Antibiotic prophylaxis should be administered in a single dose 30-60 minutes before the procedure

In the event that the dosage of antibiotic is inadvertently not administered before the procedure, it may be administered up to two hours after the procedure

For patients that are concurrently receiving an antibiotic that is the same as that recommended for IE prophylaxis, then a drug from a different class should be selected for the prophylaxis.