AHA revised guidelines for endocarditis prophylaxis in 2007. Cardiac lesions are classified into low, moderate and high risk for developing endocarditis. Antibiotic prophylaxis is recommended for moderate and high risk lesions. Low risk lesions are considered to be negligible consequence therefore antibiotic prophylaxis is not recommended.
Summary of AHA guidelines:
- Infective endocarditis is an uncommon, life-threatening condition for which prevention is preferable over treatment of an established infection.
- Specific cardiac lesions predispose to endocarditis.
- Bacteremias with microorganisms known to cause endocarditis can occur in association with invasive dental, gastrointestinal or genitourinary tract procedures.
- In experimental animal models, antimicrobial prophylaxis has been shown to prevent endocarditis.
- Antimicrobial prophylaxis is likely effective in prevention of endocarditis in patients who undergo dental, gastrointestinal and genitourinary tract procedures.
Endocarditis Prophylaxis is Indicated In:
- Previous IE: anyone with previous infective endocarditis
- Prosthetic Material: prosthetic valves, prosthetic material in repaired congenital heart disease (CHD)
- Existing Cardiac Defects: unrepaired cyanotic CHD or partially repaired CHD
- Transplantation: heart transplant patients with concomitant valvulopathies
Endocarditis Prophylaxis is NOT Indicated In:
- GI/GU procedures (ie: no abx solely to prevent BE)
- Certain dental/airway/respiratory tract procedures or procedures involving infected skin, skin structures or musculoskeletal tissues only for “highest risk patients”
- MVP, HOCM, Bicuspid AV do not require prophylaxis
AHA regimens for prophylaxis prior to dental procedures (to be taken 1 hour prior to procedure)
- Usual antibiotic
- Amoxicillin PO 2 g (adults) and 50 mg/kg (children)
- Unable to take PO
- Ampicillin IV/IM 2 g (adults) and 50 mg/kg (children)
- Cephazolin or Ceftriaxone IV/IM 1 g (adults) and 50 mg/kg (children)
- Allergic to penicillin/ampicillin
- Clindamycin PO 600 mg (adults) and 20 mg/kg (children)
- Cephalexin PO 2 g (adults) and 50 mg/kg (children)
- Azithromycin or Clarithromycin PO 500 mg (adults) and 15 mg/kg (children)
- Allergic to penicillin/ampicillin and unable to take PO
- Clindamycin IV 600 mg (adults) and 20 mg/kg (children)
- Cefazolin or Ceftriaxone IV/IM 1 g (adults) and 50 mg/kg (children)
Wilson, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation: 2007, 116(15);1736-54