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Table 83-5

Antibiotic Regimens for Prophylaxis of Endocarditis in Adults with High-Risk Cardiac Lesionsa,b

  • Standard oral regimen

    Amoxicillin: 2 g PO 1 h before procedure

  • Inability to take oral medication

    Ampicillin: 2 g IV or IM within 1 h before procedure

  • Penicillin allergy
    1. Clarithromycin or azithromycin: 500 mg PO 1 h before procedure
    2. Cephalexinc : 2 g PO 1 h before procedure
    3. Clindamycin: 600 mg PO 1 h before procedure
  • Penicillin allergy, inability to take oral medication
    1. Cefazolinc or ceftriaxonec : 1 g IV or IM 30 min before procedure
    2. Clindamycin: 600 mg IV or IM 1 h before procedure

a Dosing for children: for amoxicillin, ampicillin, cephalexin, or cefadroxil, use 50 mg/kg PO; cefazolin, 25 mg/kg IV; clindamycin, 20 mg/kg PO or 25 mg/kg IV; clarithromycin, 15 mg/kg PO; and vancomycin, 20 mg/kg IV.

b For high-risk lesions, see Table 83-4 High-Risk Cardiac Lesions for Which Endocarditis Prophylaxis Is Advised before Dental Procedures . Prophylaxis is not advised for other lesions.

c Do not use cephalosporins in pts with immediate hypersensitivity (urticaria, angioedema, anaphylaxis) to penicillin.

Source: Wilson W et al: Prevention of infective endocarditis. Circulation 116:1736, 2007; Habib G et al: Guidelines on the prevention, diagnosis, and treatment of infective endocarditis. Eur Heart J 30:2369, 2009.