Antibiotic Recommendations for Patients Requiring Premedication Before Dental Procedures

Standard Prophylactic Regimen for patients at risk, including those with prosthetic heart valves

The June 1997 recommendation of the American Heart Association calls for a single dose of Amoxicillin , to be given one hour before the procedure. (There is no longer a recommendation to give a second dose 6 hours later.)

Amoxicillin:
Adults: 2 grams (2,000 mg)
Children: 50 mg/kg

For patients unable to take penicillin, a single dose of either Clindamycin, Cephalexin, Cefadroxil, Azithromycin or Clarithromycin is given one hour before the procedure. (Cephalexin or Cefadroxil should not be used in patients with an immediate hypersensitivity reaction to penicillins.) There is no longer a recommendation to give a second dose 6 hours later.

Clindamycin:
Adults: 600 mg
Children: 20 mg/kg

Cephalexin/Cefadroxil ( not for penicillin-allergic patients):
Adults: 2 grams (2,000 mg)
Children: 50 mg/kg

Azithromycin/Clarithromycin:
Adults: 500 mg
Children:15 mg/kg

Cardiac conditions for which prophylaxis is or is not recommended:

Recommended:

High risk category: Prosthetic cardiac valves, including bioprosthetic and homograft valves; previous bacterial endocarditis; complex cyanotic congential heart disease (e.g. single ventricle states, transposition of the great arteries, tetralogy of Fallot); surgically constructed systemic-pulmonary shunts or conduits.

Moderate risk category: Most other congential cardiac malformations (other than those below); acquired valvular dysfunction (e.g. rheumatic heart disease); hypertrophic cardiomyopathy; mitral valve prolapse with valvular regurgitation and/or thickened leaflets.

Not Recommended:

Negligible risk category: Isolated secundum atrial septal defect; surgical repair of atrial septal defect, ventricular septal defect or patent ductus arteriosus (without residua beyond 6 months); previous coronoary bypass graft surgery; mitral valve prolapse without valvular regurgitation; physiologic, functional or innocent heart murmurs; previous rheumatic fever without valvular dysfunction; cardiac pacemakers (intravascular and epicardial); implanted defibrillators.

Dental procedures for which prophylaxis is or is not recommended:

Recommended:

Extractions; periodontal procedures including probing, scaling and root planing and surgery; recall maintenance; dental implant placement; re-implantation of avulsed teeth; endodontic treatment only beyond the apex; subgingival placement of antibiotic fibers/strips; initial placement of orthodontic bands (but not brackets); intraligamentary local anesthetic injections; prophylactic cleaning of teeth or implants where bleeding is anticipated.

Not Recommended:

Restorative dentistry (operative and prosthodontic) with or without retraction cord except where significant bleeding is anticipated; local anesthetic injections (non-intraligamentary); intracanal endodontics; post placement and build-up; placement of rubber dams; suture removal; placement of removable appliances; electrosurgery after postoperative suture removal; taking of impressions; fluoride treatments; taking of radiographs; shedding of primary teeth; orthodontic appliance adjustment.