I. Background: Rationale regarding Guideline changes from 1997 to 2007

  1. Endocarditis is far more frequent randomly than during dental and other procedures
  2. Prophylaxis prevents few endocarditis cases
  3. Risk of adverse events from antibiotics outweighs benefit of endocarditis prevention
  4. Optimal Oral Hygiene is key in endocarditis prevention
    1. Much more important than SBE antibiotic prophylaxis

II. Indications: Prophylaxis recommended

  1. Prosthetic cardiac valves (biograft and homograft)
  2. Previous Bacterial Endocarditis with or without heart disease
  3. Specific congenital cardiac malformations
    1. Unrepaired Cyanotic Congenital Heart Disease
    2. Completely repaired Congenital Heart Disease with prosthetic material in first 6 months
    3. Partially repaired Congenital Heart Disease with residual defect
  4. Cardiac Transplantation recipients with cardiac valvulopathy

III. Indications: Prophylaxis NOT recommended (significant change from prior guidelines)

  1. Rheumatic and other acquired valve dysfunction
  2. Hypertrophic Cardiomyopathy
  3. Mitral Valve Prolapse with valvular regurgitation
  4. Isolated secundum Atrial Septal Defect (ASD)
  5. Surgical repair of secundum ASD, VSD, or PDA
    1. Without residual defect beyond 6 month post-operative period
  6. Previous Coronary Artery Bypass (CABG)
  7. Mitral Valve Prolapse without valvular regurgitation
  8. Physiologic, functional, or innocent Heart Murmurs
  9. Previous Kawasaki Disease without valve dysfunction
  10. Cardiac Pacemakers and implanted Defibrillators

IV. Indications: Procedures warranting prophylaxis

  1. Invasive respiratory procedures (e.g. bronchoscopy)
  2. Dental Procedures
    1. Gingival or periapical region of teeth manipulated or
    2. Oral Mucosa perforated
  3. SBE Prophylaxis not indicated in other procedures
    1. Gastrointestinal and genitourinary procedures do not require SBE Prophylaxis
    2. Perioperative antibiotic prophylaxis may be indicated for reasons outside of SBE Prophylaxis

V. Protocol: General

  1. Oral prophylaxis given 1 hour before procedure
  2. IV prophylaxis given 30 minutes before procedure
  3. Dose after procedure not recommended in 2007 guidelines

VI. Protocol: Adult Prophylaxis: Dental, Oral, Respiratory, Esophageal

  1. Standard Regimen
    1. Amoxicillin 2g PO 1h before procedure or
    2. Ampicillin 2g IM/IV 30m before procedure
  2. Penicillin Allergic
    1. Clindamycin
      1. 600 mg PO 1h before procedure or
      2. 600 mg IV 30m before
    2. Cephalexin OR Cefadroxil 2g PO 1 hour before
    3. Cefazolin or Ceftriaxone 1.0g IM/IV 30 min before procedure
    4. Azithromycin or Clarithromycin 500mg PO 1h before

VII. Protocol: Child Prophylaxis: Dental, Oral, Respiratory, Esophageal

  1. Standard Regimen
    1. Amoxicillin 50 mg/kg (MAX 2g) 1h before procedure
    2. Ampicillin 50 mg/kg (MAX 2g) IM/IV 30m before
  2. Penicillin Allergic
    1. Clindamycin
      1. Oral: 20 mg/kg PO 1h (MAX 600mg) before or
      2. IV: 20 mg/kg (MAX 600mg) IV 30m before
    2. Cephalexin 50 mg/kg (MAX 2g) PO 1h before or
    3. Cefadroxil 50 mg/kg (MAX 2g) PO 1h before or
    4. Cefazolin or Ceftriaxone 50 mg/kg (MAX 1g) IM/IV 30m before
    5. Azithromycin 15 mg/kg (MAX 500mg) PO 1h before or
    6. Clarithromycin 15 mg/kg (MAX 500mg) PO

VIII. Protocol: Gastrointestinal or Genitourinary prophylaxis

  1. No longer recommended (see above)
  2. Prior guidelines (1997)
    1. High risk patients were given Ampicillin and Gentamicin before and Ampicillin after procedure
    2. Moderate risk patients were given Ampicillin before and after procedure
    3. Penicillin allergic patients were given Vancomycin in place of Ampicillin

Images: Related links to external sites (from Google)

Ontology: Subacute bacterial endocarditis prophylaxis (C0038519)

Concepts Therapeutic or Preventive Procedure (T061)
SnomedCT 426931009
English SUBACUTE BACTERIAL ENDOCARDITIS PROPHYLAXIS, SBE PROPHYLAXIS, Subacute bacterial endocarditis prophylaxis (procedure), Subacute bacterial endocarditis prophylaxis, S.B.E. prophylaxis, SBE prophylaxis, ENDOCARDITIS BACTERIAL SUBACUTE PROPHYLAXIS, sbe prophylaxis, prophylaxis sbe
Spanish profilaxis de endocarditis bacteriana subaguda (procedimiento), profilaxis de endocarditis bacteriana subaguda

Ontology: Endocarditis prophylaxis (C1396567)

Concepts Therapeutic or Preventive Procedure (T061)
Dutch endocarditisprofylaxe, endocarditis; profylaxe, profylaxe; endocarditis
French Prophylaxie anti-endocardite
German Endokarditis-Prophylaxe
Italian Profilassi per endocardite
Portuguese Profilaxia da endocardite
Spanish Profilaxis de endocarditis
Japanese 心内膜炎予防, シンナイマクエンヨボウ
English endocarditis prophylaxis (treatment), endocarditis prophylaxis, endocarditis; prophylaxis, prophylaxis; endocarditis, Endocarditis prophylaxis
Czech Endocarditis prophylaxis
Hungarian Endocarditis profilaxis