Antibiotic Prophylaxis for Infective Endocarditis in Dental Patients Undergoing Interventional Procedures

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A guideline is intended to assist healthcare professionals in the choice of disease-specific treatments.

Clinical judgement should be exercised on the applicability of any guideline, influenced by individual patient characteristics. Clinicians should be mindful of the potential for harmful polypharmacy and increased susceptibility to adverse drug reactions in patients with multiple morbidities or frailty.

If, after discussion with the patient or carer, there are good reasons for not following a guideline, it is good practice to record these and communicate them to others involved in the care of the patient.

Notice

Antibiotic prophylaxis is NOT routinely required for the majority of patients undergoing dental procedures.

Which patients require antibiotic prophylaxis?

Healthcare professionals should regard patients with the following cardiac conditions as being at increased risk of developing infective endocarditis and prescribe these patients antibiotics:

  • Patients with any prosthetic valve, including a transcatheter valve, or those in whom anyprosthetic material was used for cardiac valve repair;
  • Patients with a previous episode of infective endocarditis
  • Patients with cyanotic congenital heart disease (CHD) who continue to be cyanosed
  • Any type of CHD repaired with a prosthetic material, whether placed surgically or bypercutaneous techniques, up to 6 months after the procedure or lifelong if residual shunt orvalvular regurgitation remains

In all cases clinicians should discuss the risks associated with/without antimicrobial prophylaxis with the patient and record in clinical records as appropriate. Advice should also be given on symptoms that may indicate infective endocarditis and when to seek expert advice.

Antibiotic Prophylaxis Required

Single dose 60 minutes before the procedure.

  Antibiotic
Adults Oral Amoxicillin 3g (Single dose Oral Powder Sachet)
In true penicillin or beta lactam allergy
Oral Clindamycin 600mg
Children Oral Amoxicillin 50mg/kg (maximum dose 3g)
In true penicillin or beta lactam allergy
Oral Clindamycin 20mg/kg (maximum dose 600mg)

References

  1. Prophylaxis against infective endocarditis: antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures, 2016 https://www.nice.org.uk/guidance/CG64/chapter/Recommendations. Accessed 28 April 2021
  2. Infective Endocarditis (Guidelines on Prevention, Diagnosis and Treatment of), 2015
    https://academic.oup.com/eurheartj/article/36/44/3075/2293384 Accessed 28 Jan 2021

Last reviewed: 19 May 2021

Next review: 31 May 2024

Author(s): Ysobel Grourlay

Version: 2

Author Email(s): [email protected]

Approved By: Antimicrobial Utilisation Committee