CANADIAN ADULT CONGENITAL HEART NETWORK

Bacteremia resulting from daily activities is much more likely to cause infective endocarditis (IE) than bacteremia associated with dental procedures.
Prophylaxis may prevent an exceedingly a small number of cases with IE, if any, in individuals who undergo a dental, gastrointestinal or genitor-urinary tract procedure.
The risk of antibiotic associated adverse events exceeds the benefit, if any, from prophylactic antibiotic therapy.
Maintenance of optimal oral health and hygiene may reduce the incidence of bacteremia from daily activities and is more important than prophylactic antibiotics for a dental procedure to reduce the risk of IE.
Only an extremely small number of cases with IE might be prevented by antibiotic prophylaxis even if prophylaxis is 100% effective.

Cardiac Conditions Associated With the Highest Risk of Adverse Outcome From Endocarditis for Which Prophylaxis With Dental Procedures Is Recommended

Prosthetic cardiac valve

Previous Infective Endocarditis

Congenital Heart Disease (CHD)*:

Unrepaired cyanotic CHD, including palliative shunts and conduits
Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure†
Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)

Cardiac transplantation recipients who develop cardiac valvulopathy

*Except for the conditions listed below, antibiotic prophylaxis is no longer recommended for any other form of CHD.
†Prophylaxis is recommended because endothelialization of prosthetic material occurs within 6 months after the procedure.

Dental Procedures for Which Endocarditis Prophylaxis Is Recommended

All dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa*

*The following procedures and events do not need prophylaxis: routine anesthetic injections through noninfected tissue, taking dental radiographs, placement of removable prosthodontic or orthodontic appliances, adjustment of orthodontic appliances, placement of orthodontic brackets, shedding of deciduous teeth, and bleeding from trauma to the lips or oral mucosa.

Antibiotic Regimens in ADULTS for a Dental Procedure

Situation	Regimen (Single dose 30 to 60 min before procedure)
Standard general prophylaxis for patients at risk	AMOXICILLIN 2.0g orally
Unable to take oral medications	AMPICILLIN 2.0g IM or IV , or CEFAZOLIN or CEFTRIAXONE† 1.0 g IM or IV
Allergic to penicillins or ampicillin—oral	CEPHALEXIN *† 2 g, or CLINDAMYCIN 600mg, or AZITHROMYCIN 500 mg, or CLARITHROMYCIN 500mg
Allergic to penicillins or ampicillin and unable to take oral medication	CEFAZOLIN OR CEFTRIAXONE† 1.0 g IM or IV, or CLINDAMYCIN 600mg IM or IV
IM indicates intramuscular; IV, intravenous. *Or other first- or second-generation oral cephalosporin in equivalent dosage. †Cephalosporins should not be used in an individual with a history of anaphylaxis, angioedema, or urticaria with penicillins or ampicillin.

Recommendations for Other Invasive Procedures

Antibiotic prophylaxis is recommended for procedures on respiratory tract or infected skin, skin structures, or musculoskeletal tissue only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from IE.

Antibiotic prophylaxis solely to prevent IE is not recommended for gastrointestinal and genitourinary tract procedures including vaginal delivery and hysterectomy.

Endocarditis prophylaxis is not recommended for ear and body piercing and tattooing.