NCEMI eTools

Antibiotic regimens for endocarditis prophylaxis
See the text of the actual statement for further comments

Cephalosporins are a substitute for patients allergic to penicillin BUT they should NOT be used in individuals with immediate-type hypersensitivity reaction (urticaria, angioedema, or anaphylaxis) to penicillins
American Heart Association Website
Search PubMed

Dental, Oral, Respiratory Tract, or Esophageal Procedures
SITUATIONADULT REGIMENCHILDREN'S REGIMEN (Total children's dose should not exceed adult dose)
Standard general prophylaxisAmoxicillin 2 g 1 h before procedureAmoxicillin 50 mg/kg orally 1 h before procedure
Unable to take oral medsAmpicillin 2 g I.M./I.V. within 30 min before procedureAmpicillin 50 mg/kg I.M./I.V. within 30 min before procedure
Allergic to penicillinClindamycin 600 mg 1 h before procedure
--or--
Cephalexin or cefadroxil 2 g 1 h before procedure
--or--
Azithromycin or clarithromycin 500 mg 1 h before procedure
Clindamycin 20 mg/kg orally 1 h before procedure
--or--
Cephalexin or cefadroxil 50 mg/kg orally 1 h before procedure
--or--
Azithromycin or clarithromycin 15 mg/kg orally 1 h before procedure
Unable to take oral meds and allergic to penicillinClindamycin 600 mg IV within 30 min before procedure
--or--
Cefazolin 1 g IV/IM within 30 min before procedure
Clindamycin 20 mg/kg IV within 30 min before procedure
--or--
Cefazolin 25 mg/kg IV/IM within 30 min before procedure
------

Genitourinary/Gastrointestinal (Excluding Esophageal) Procedures
SITUATIONADULT REGIMENCHILDREN'S REGIMEN (Total children's dose should not exceed adult dose)
High Risk PatientsAmpicillin 2 g I.M. or I.V. plus gentamicin 1.5 mg/kg (not to exceed 120 mg) within 30 min of starting the procedure; 6 h later, ampicillin 1 g I.M./I.V. or amoxicillin 1 g orallyAmpicillin 50 mg/kg I.M./I.V. (not to exceed 2 g) plus gentamicin 1.5 mg/kg within 30 min of starting the procedure; 6 h later, ampicillin 25 mg/kg I.M./I.V. or amoxicillin 25 mg/kg orally
High-risk patients allergic to ampicillin/amoxicillinVancomycin 1 g I.V. over 1-2 h plus gentamicin 1.5 mg/kg I.M./I.V. (not to exceed 120 mg); complete injection/infusion within 30 min of starting the procedureVancomycin 20 mg/kg I.V. over 1-2 h plus gentamicin 1.5 mg/kg I.M./I.V.; complete injection/infusion within 30 min of starting the procedure
Moderate Risk PatientsAmoxicillin 2 g orally 1 h before procedure, or ampicillin 2 g I.M./I.V within 30 min of starting the procedureAmoxicillin 50 mg/kg orally 1 h before procedure, or ampicillin 50 mg/kg I.M./I.V. within 30 min of starting the procedure
Moderate-risk patients allergic to ampicillin/amoxicillinVancomycin 1 g I.V. over 1-2 h; complete infusion within 30 min of starting the procedureVancomycin 20 mg/kg I.V. over 1-2 h; complete infusion within 30 min of starting the procedure

Copyright 1995-2004 by National Center for Emergency Medicine Informatics. All Rights Reserved.