Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

APPENDIX A: PREVENTION OF INFECTIVE ENDOCARDITISAmerican Heart Association Guidelines - 2007Recommended standard prophylactic regimen for patients at highest risk of infective endocarditis for all dental procedures that involvemanipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa, for procedures involving incision or biopsyof the respiratory mucosa, or for surgical procedures involving infected skin, skin structures, or musculoskeletal tissue.Patients at highest risk for infective endocarditis include those with prosthetic cardiac valve, history of infective endocarditis, unrepaired cyanoticcongenital heart disease, completely reparied congenital heart defect with prosthetic material or device during the first 6 months after the procedure,repaired congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic patch or device, or cardiac transplantationrecipients who develop cardiac valvulopathy.CONDITION DRUG ADULT DOSE PEDIATRIC DOSE*Standard oral regimen Amoxicillin 2 g PO 30 – 60 minutes before procedure 50 mg/kg PO 30 – 60 minutes beforePatients unable to takeoral medicationsAllergic to penicillins orampicillin - oralPatients unable to takeoral medications andare allergic to penicillinsor ampicillinprocedureAmpicillin 2 g IV/IM 30 – 60 minutes before procedure 50 mg/kg IV/IM 30 – 60 minutes beforeprocedureCefazolin or ceftriaxone 1 g IV/IM 30 – 60 minutes before procedure 50 mg/kg IV/IM 30 – 60 minutes beforeprocedureCephalexin*† 2 g PO 30 – 60 minutes before procedure 50 mg/kg PO 30 – 60 minutes beforeprocedureClindamycin 600 mg PO 30 – 60 minutes before procedure 20 mg/kg PO 30 – 60 minutes beforeprocedureAzithromycin orclarithromycin500 mg PO 30 – 60 minutes before procedure 15 mg/kg PO 30 – 60 minutes beforeprocedureCefazolin or ceftriaxone† 1 g IV/IM 30 – 60 minutes before procedure 50 mg/kg IV/IM 30 – 60 minutes beforeprocedureClindamycin 600 mg IV/IM 30 – 60 minutes before procedure 20 mg/kg IV/IM 30 – 60 minutes beforeprocedure*Or other first-or second-generation oral cephalosporin in equivalnet adult or pediatric dosage†Cephalosporins should not be used in an individual with a history of anaphylaxis, angioedema, or urticaria with penicillins orampicillin