ABSTRACT
Endocarditis prophylaxis not recommended Restorative dentistry† (operative and prosthodontic)
with/without retraction cord Local anesthetic injections (nonintraligamentary)* Intracanal endodontic treatment: postplacement and
buildup Placement of rubber dams Postoperative suture removal Placement of removable prosthodontic/orthodontic
appliances Taking of oral impressions Fluoride treatments Taking of oral radiographs Orthodontic appliance adjustment Shedding of primary teeth
Table 5 Endocarditis prophylaxis for dental procedures
*Intraligamentary injections are directed between the root and bone to deliver anesthetic agents to the periosteum of the bone.†Includes filling cavities and replacement of missing teeth. In selected circumstances, especially with significant bleeding, antibiotic use may be indicated. (Adapted from Bonow RO, Carabello B, de Leon AC Jr, et al. (1998).ACC/AHA guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease). Journal of the American College of Cardiology 32:1486-1588.)
unpredictable (e.g. pneumonia), some are iatrogenic. The latter result from procedures which involve significant trauma to a colonized or infected site (e.g. dental, gastrointestinal [GI], or genitourinary [GU] procedures). On the basis of animal studies, the American Heart Association (AHA) has made
endocarditis (Dajani et al., 1997). Prophylaxis is recommended for cardiac conditions considered at moderate or high risk (Table 4). Likewise, medical and dental procedures are stratified to those which do and do not require antibiotics (Tables 5, 6). To address the variation in flora residing in the mouth,
Endocarditis prophylaxis recommended Respiratory tract
Tonsillectomy/adenoidectomy Surgical operations involving respiratory mucosa Bronchoscopy with rigid bronchoscope
Gastrointestinal tract (prophylaxis for high-risk patients; optimal for moderate risk) Sclerotherapy for esophageal varices Esophageal stricture dilation Endoscopic retrograde cholangiography with biliary
obstruction Biliary tract surgery Surgical operations involving intestinal mucosa
Genitourinary tract Prostatic surgery Cystoscopy Urethral dilation
Endocarditis prophylaxis not recommended Respiratory tract
Endotracheal intubation Bronchoscopy with a flexible bronchoscope, with
or without biopsy* Tympanostomy tube insertion
Gastrointestinal tract Transesophageal echocardiography* Endoscopy with or without gastrointestinal biopsy*
Genitourinary tract Vaginal hysterectomy* Vaginal delivery* Cesarian section
In uninfected tissue: Urethral catheterization Uterine dilation and curettage Therapeutic abortion Sterilization procedures Insertion or removal of intrauterine devices
Other Cardiac catheterization, including balloon angioplasty Implantation of cardiac pacemakers, implantable
defibrillators, and coronary stents Incision or biopsy of surgically scrubbed skin Circumcision
Table 6 Endocarditis prophylaxis for nondental procedures
*Prophylaxis is optional for high-risk patients. (Adapted from Bonow RO, Carabello B, de Leon AC Jr, et al. (1998). ACC/AHA guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease). Journal of the American College of Cardiology 32:1486-1588.)
tailored to address the resident flora of the body cavity, the level of risk to the patient, and any adverse drug reaction history (Tables 7, 8).
