Antibiotic protocol for endocarditis prevention in dental procedures

June 09, 2013


Antibiotic protocol for endocarditis prevention in dental procedures
Antibiotics used in dental procedures

Antibiotic protocol - local anaesthesia/no anaesthesia

Oral amoxicillin 3g 1 hour before the dental procedure
Or/if the patient is allergic to penicillin or have had more than a single dose in previous month: oral clindamycin 600 mg 1 hour before the procedure
Or patients who have had endocarditis: amoxicillin and gentamycin, as under general anaesthesia

Antibiotic protocol - general anaesthesia with no special risk

Amoxicillin 1g intravenous at induction, then oral amoxicillin 500mg 6 hours later
Or oral amoxicillin 3g 4 hours before induction then oral amoxicillin 3g right after procedure
Or oral amoxicillin 3g and oral probenecid 1g 4 hours before procedure

Antibiotic protocol - general anaesthesia with special risk

Patients with a prosthetic valve or who have had endocarditis are at special risk
Amoxicillin 1g and gentomycin 120mg both intravenous at induction, then oral amoxicillin 500mg 6 hours later

Antibiotic protocol - general anaesthesia, when the patient cannot take penicillin

These are patients allergic to penicillin or who have received more than a single dose of a penicillin in the previous month. They need different antibiotic treatment
Vancomycin 1 g intravenous over at least 100 minutes then intravenous gentamycin 120mg at induction or 15 minutes before procedure
Or teicoplanin 400mg and gentamycin 120mg both intravenous at induction or 15 minutes before procedure
Or clindamycin 300mg intravenous over at least 10 minutes at induction or 15 minutes before procedure then oral or intravenous clindamycin 150mg 6 hours later

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