Antibiotic Guidelines

Modified recommendations by the American Heart Association (JAMA 277:22:1794, 1997)

Who requires SBE prophylaxis?

• All unoperated congenital cardiac defects except an uncomplicated atrial septal defect
• Rheumatic and other acquired valvular abnormalities
• All postoperative cardiac patients except those with no residua six months following pacemaker implantation, heart transplantation or repair of atrial septal defect, ventricular septal defect or patent ductus arteriosus
• Any patient with a previous episode of endocarditis even in the absence of underlying heart disease
• Hypertrophic cardiomyopathy
• Mitral valve prolapse with regurgitation and/or thickened leaflet

What procedures are indications for SBE prophylaxis?

• All dental procedures likely to involve bleeding (extraction, cleaning, drilling); however, shedding of primary teeth and adjustment of orthodontic appliances do not require prophylaxis
• Tonsillectomy, adenoidectomy, bronchoscopy (using rigid bronchoscope) or any surgical procedure involving respiratory mucosa; however, it is not necessary for endotracheal intubation or myringotomy with tube insertion
• Incision and drainage of infected tissue
• Any surgical or invasive procedure involving the gastrointestinal or genitourinary system, except for endoscopy without biopsy, urethral catheterization in the absence of infection, hernia repair, circumcision and lacerations not requiring sutures

Regimen for Dental, Oral, Upper Respiratory Tract or Esophageal Procedures

All Patients

Initial dose: one hour before procedure ORALLY, or 30 minutes before procedure IM or IV. A Follow-up dose is no longer recommended.

1. Standard (not allergic to Penicillin)

   Drug	Route	40kg (88 lbs)	40kg (88 lbs)
   Amoxicillin	Oral	50 mg/kg	2 gm
   Ampicillin	IV or IM	50 mg/kg	2 gm

2. Penicillin Allergy or patients on daily rheumatic fever prophylaxis; or patients receiving Penicillin/Amoxicillin
   

   Drug	Route	30kg (66 lbs)	30kg (66 lbs)
   Clindamycin	Oral or IV	20 mg/kg	600 mg

Regimen for Gastrointestinal/Genitourinary Procedures (excluding esophageal)

High-risk Patients (prosthetic valve, previous SBE, complex cyanotic heart disease, systemic to pulmonary shunts or conduits)

1. Standard (not allergic to Penicillin)
   Initial Dose (IM or IV only): Ampicillin 50 mg/kg (max. 2 gm) plus Gentamycin 1.5 mg/kg (max. 120 mg)
   Follow-up Dose (6 hrs. later): Amoxicillin 25 mg/kg (max. 1 gm) orally or Ampicillin 25 mg/kg (max. 1 gm)
2. Penicillin Allergy
   Initial Dose: Vancomycin 20 mg/kg (max. 1 gm) IV over 1-2 hours plus Gentamycin 1.5 mg/kg (max. 120 mg)
   Complete infusion within 30 minutes of starting the procedure.

All Other Patients

1. Standard (not allergic to Penicillin)
   Follow recommendations above for dental procedures.
2. Penicillin Allergy
   Vancomycin 20 mg/kg (max. 1 gm) IV over 1-2 hours
   Complete infusion within 30 minutes of starting the procedure.