Endocarditis Prophylaxis

Comments from Expert Advisory Committee

These recommendations are taken from the European Society of Cardiology (ESC) Guidelines on the Prevention, Diagnosis and Treatment of Infective Endocarditis, 200913

Endocarditis prophylaxis is only recommended in the situations detailed below, as antibiotic prophylaxis may only be effective at preventing a very small number of endocarditis cases. Infective endocarditis is much more likely to be caused by frequent exposure to random bacteraemias than bacteraemias caused by dental, GI tract or GU tract procedures. The risk of antibiotic related adverse events exceeds the benefit, if any, from prophylactic antibiotic therapy.

Maintenance of optimal oral health and hygiene and regular dental review are important in reducing the risk of endocarditis from dental procedures.

Cardiac conditions at the highest risk of infective endocarditis for which prophylaxis is recommended when a high risk procedure is performed:

  1. Patients with a prosthetic cardiac valve or a prosthetic material used for cardiac valve repair.
  2. Patients with previous infective endocarditis
  3. Patients with congenital heart disease:

a. cyanotic heart disease, without surgical repair, or with residual defects, palliative shunts or conduits
b. congenital heart disease with complete repair with prosthetic material whether placed by surgery or percutaneous technique, up to 6 months after the procedure.
c. when a residual defect persists at the site of implantation of a prosthetic material or device by cardiac surgery or percutaneous technique

Antibiotic prophylaxis is no longer recommended in other forms of valvular or congenital heart disease.

Antibiotic prophylaxis should be considered only in patients with the above cardiac conditions, and only for dental procedures requiring manipulation of the gingival or periapical region of the teeth or perforation of the oral mucosa (this includes scaling and root canal procedures)

Antibiotic prophylaxis is NOT recommended for the following:

a. Local anaesthetic injections in non-infected tissue
b. Removal of sutures
c. Dental X-rays
d. Placement or adjustment of removable prosthodontic or orthodontic appliances or braces
e. Shedding of deciduous teeth
f. Trauma to the lips and oral mucosa

Recommended prophylaxis for dental procedures at risk


See guidance on dosing in children for quick reference dosage/weight guide.

Given as a single dose 30- 60 minutes prior to the procedure
Amoxicillin 2 grams orally /iv
Amoxicillin 50mg/kg orally or iv
1st line option In penicillin allergy
Clindamycin 600mg orally / iv /im
Clindamycin 20mg/kg orally/iv

Patient Information

Visit HPSC Information Leaflets pages for the General Public, (MRSA, CRE, etc)

Reviewed June 2016

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