PREVENTION OF INFECTIVE ENDOCARDITIS
This wallet card is to be given to patients (or parents) by their
health care professional. Please see the back of the card for
reference to the complete statement.
Name: _
Needs protection from
INFECTIVE ENDOCARDITIS
because of an existing heart condition.
Diagnosis:
Prescribed by:
Date:
You received this wallet card because you are at increased risk for
developing adverse outcomes from infective endocarditis (IE). The
recommendations for the prevention of IE shown in this card are based on
the most current evidence.
Members of the American College of Cardiology/American Heart Association
Joint Committee on Clinical Practice Guidelines and the American Heart
Association’s Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee,
together with national and international experts on IE, extensively reviewed
published studies to determine whether dental, gastrointestinal (GI) or
genitourinary (GU) tract procedures are possible causes of IE. Findings from
these studies showed no conclusive evidence linking GI or GU tract procedures
with the development of IE. They also concluded that antibiotics before
dental procedures are reasonable only for certain patients at increased risk
of developing IE and at the highest risk of poor outcomes from IE.
The practice of routinely giving antibiotics to patients at risk for IE before
dental procedures is not recommended EXCEPT for patients with the high-
est risk of adverse outcomes resulting from IE (see below on this card).
The Committees concluded that only a small number of IE cases might be
prevented by antibiotic prophylaxis before a dental procedure. In addition,
prophylaxis should be reserved ONLY for patients with cardiac conditions
associated with the highest risk that are listed below. You can reduce the risk
of IE by maintaining good oral health through regular professional dental
care and the use of dental products, such as manual, powered and ultrasonic
toothbrushes; dental floss; and other plaque-removal devices.
This guidance does not change the fact that your cardiac condition may
increase your risk of developing IE. If you develop signs or symptoms of IE —
such as unexplained fever — see your health care professional right away.
If blood cultures are necessary (to determine if endocarditis is present), it is
important for your health care professional to obtain these cultures and other
relevant tests BEFORE antibiotics are started.
Antibiotic prophylaxis is reasonable before dental procedures that involve
manipulation of the gingival tissue, manipulation of the periapical region
of teeth, or perforation of the oral mucosa in patients with valvular heart
disease who have any of the following:
• Prosthetic cardiac valves, including transcatheter-implanted prostheses
and homografts
• Prosthetic material used for cardiac valve repair, such as annuloplasty
rings, chords or clips
• Previous IE
• Unrepaired cyanotic congenital heart defect (CHD) or repaired CHD, with
residual shunts or valvular regurgitation at the site of or adjacent to the
site of a prosthetic patch or prosthetic device*
• C
ardiac transplant with valve regurgitation due to a structurally
abnormal valve
* Except for the conditions listed above, antibiotic prophylaxis before dental
procedures is not recommended for any other types of CHD.
Dental procedures for which prophylaxis is reasonable in patients with
cardiac conditions are listed on the reverse side.
Antibiotic prophylaxis is NOT recommended for the following dental procedures
or events: Routine anesthetic injections through noninfected tissue; taking dental
radiographs; placement of removable prosthodontic or orthodontic appliances;
adjustment of orthodontic appliances; placement of orthodontic brackets; and
shedding of deciduous teeth and bleeding from trauma to the lips or oral mucosa.
Antibiotic Prophylactic Regimens
for Dental Procedures
Regimen – Single dose 30 to 60 minutes before procedure
Situation Agent Adults Children
Oral Amoxicillin 2g 50 mg/kg
50 mg/kg
Unable to Ampicillin OR 2 g IM or IV
IM or IV
take oral
medication Cefazolin or 50 mg/kg
1 g IM or IV
ceftriaxone IM or IV
Cephalexin* 2g 50 mg/kg
OR
Allergic to Azithromycin or
penicillin or 500 mg 15 mg/kg
clarithromycin
ampicillin—
oral regimen OR
<45 kg,
Doxycycline 100 mg 2.2 mg/kg
>45 kg, 100 mg
Allergic to
penicillin or
Cefazolin or 50 mg/kg
ampicillin and 1 g IM or IV
ceftriaxone† IM or IV
unable to take
oral medication
Clindamycin is no longer recommended for antibiotic prophylaxis for a dental procedure.
IM indicates intramuscular; and IV, intravenous.
* Or other first- or second-generation oral cephalosporin in equivalent adult or
pediatric dosing.
† Cephalosporins should not be used in an individual with a history of anaphylaxis,
angioedema, or urticaria with penicillin or ampicillin.
Nondental Procedures: In patients with valvular heart disease who are at
high risk of IE, antibiotic prophylaxis is not recommended for nondental
procedures, such as TEE, esophagogastroduodenoscopy, colonoscopy or
cystoscopy, in the absence of active infection.
Other Procedures: Prophylaxis for procedures involving the respiratory
tract, infected skin and skin structures, tissues just under the skin or
musculoskeletal tissue is discussed in the documents referenced below.
Prevention of Viridans Group Streptococcal Infective Endocarditis: A Scientific Statement
From the American Heart Association. Circulation. 2021;143:e963–e978. Accessible at
[Link]
2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A
Report of the American College of Cardiology/American Heart Association Joint Committee
on Clinical Practice Guidelines. Circulation. 2021;143:e72-e227. Accessible
at [Link]
Health care professionals – Please refer to the above guidance
for additional information regarding the use of antibiotic
prophylaxis to reduce risk of infective endocarditis.
National Center
7272 Greenville Avenue
Dallas, Texas 75231-4596
[Link]
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