2010 Unofficial Summary Recommendations for Antibiotic Prophylaxis Not intended to replace clinical judgment. In case of multiple medical conditions a medical consult is recommended. 2010 Chris Rice, William Brockman, & Sharon Furby. Chart adapted from Tong et al, JADA 2000, 131:372
Area Cardiac
1-3
Vascular Grafts1-3 Shunts / Catheters / IV Access Devices Stent Prosthetic Joint5 Fen-Phen Immunocompromised
1. 2. 3. 4. 5. 6.
Medical Condition
Premed?
Previous endocarditis Prosthetic heart valves Cardiac transplantation recipients who develop cardiac valve problems Repaired Congenital Heart Disease (CHD) w/ residual defects Unrepaired cyanotic CHD (including palliative shunts and conduits) CHD completely repaired with prosthetic material or device Surgically corrected CHD (w/o residual defects) Valvular heart disease (Mitral valve prolapse, murmurs, etc) Hypertrophic cardiomyopathy Down syndrome (unless CHD as above) (high incidence of defects) Systemic Lupus Erythematosis (SLE) w/ cardiac involvement Physiologic (functional) heart murmurs Rheumatic fever with or without valve damage Intracardiac Devices (e.g. Implanted pacemaker or defibrillator) Previous coronary bypass graft surgery without complications Nonautogenous (Bovine, etc) grafts Synthetic vascular grafts (Dacron, Teflon, PTFE, etc) Surgically constructed systemic-pulmonary shunts (usually yes) Renal hemodialysis with arteriovenous (AV) shunt or (Udall) catheter (AV shunt usually yes) Hydrocephalic shunts of any type (VA, VP, or LP) (VA usually yes) Chemotherapy (Hickman or Broviac) catheters or indwelling ports Central IV lines (hyperalimentation) Angioplasty with metal stent placement Complete joint replacement (regardless of age) Pins, plates, or screws Existing dental implants, breast or penile implants, intraocular lenses Any history of use (see American Heart Association website) Chemotherapy (“for deep scaling or extractions”) AIDS (“for extraction of abscessed teeth”) Splenectomy Poorly controlled or uncontrolled diabetes Absolute Neutrophil Count <500
Yes
6 months No
Yes Med consult
No Yes No No Med consult
Lockhart PB et al. The Evidence Base for the Efficacy of Antibiotic…” JADA 2007;138(4):458-74. Wilson W et al. Prevention of Infective Endocarditis: Guidelines” Circulation 2007 116: 1736-1754 Baddour LM et al. “Nonvalvular Cardiovascular Device…” Circulation 2003 Vol. 108:2015-2031. Tong DC, Rothwell BR, “Antibiotic Prophylaxis in Dentistry…” JADA 2000, 131:372. A.D.A., http://www.ada.org/prof/resources/topics/antibiotic.asp, accessed May 2009. A.D.A., A.A.O.S. “Antibiotic Prophy for Dental Patients with Total…” JADA 1997, 128:1004-1108.
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Antibiotic Prophylactic Regimens for Certain Dental Procedures* (Individual cases may vary, please refer to reference materials) (*Adapted 2002 with permission of ADA Publishing, a Division of ADA Business Enterprises, Inc, from Tong DC, Rothwell BR. Antibiotic prophylaxis in dentistry: a review and practice recommendations. JADA 2000; 131(2):366-74. Copyright © 2000 American Dental Association.)
Situation Standard Prophylaxis Cannot Use Oral Medications Allergic to Penicillin
Antibiotic Amoxicillin Ampicillin Clindamycin Cephalexin or cefadroxil† Azithromycin or clarithromycina Clindamycin Cefazolin†
Adult 2 grams 2 grams IM or IV (<30 min. prior) 600 mg. 2 grams
Children‡ 50 mg./kg 50 mg/kg IM or IV (<30 min prior) 20 mg/kg 50 mg/kg
500 mg.
15 mg/kg
Allergic to Penicillin 600 mg. IV 15 mg/kg IV & Unable to Take Oral 1 gram IM or IV 25 mg/kg IM or IV (<30 Meds (<30 min. prior) min. prior) †Cephalosporins should not be used in patients with immediate-type hypersensitivity reaction (urticaria, angioedema or anaphylaxis) to penicillins ‡Total children’s dose should not exceed adult dose a Pregnancy category C
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