Some patients require antibiotic therapy prior to surgery

 

Endocarditis prevention

Endocarditis is an inflammation of the inner lining of the heart (endocardium). The most common structures involved are the heart valves.

Since the oral cavity is never sterile, bacteraemia inevitably occurs whenever intraoral procedures are performed. This means that bacteria enter the bloodstream for a short period of time.

Certain patients are at a higher risk of endocarditis and have a higher probability of developing a severe form of infective endocarditis. According to the position paper of the German Cardiac Society patients with the indications listed below require pre-operative antibiotic therapy for endocarditis prevention:

  • Patients with replacement valves (mechanical or biological prosthetic valves) and patients after alloprosthetic heart valve reconstruction, in the first 6 months after surgery
  • Patients with previous endocarditis
  • Patients with congenital heart disease

Cyanotic heart disease which has not been treated surgically or which has been treated palliatively by creating a systemic-to-pulmonary shunt

Heart defects that have been corrected surgically by inserting conduits (with or without valves), or residual defects, i.e. turbulent blood flow in the area of prosthetic material

Any heart defects that have been managed with surgical or interventional procedures and the use of prosthetic material, in the first 6 months after the procedure

  • Post-heart transplant patients with cardiac valvulopathy

The following treatment regimen is recommended prior to dental surgery:

    Single dose 30 to 60 minutes prior to surgery

Situation

Antibiotic

Adults

Children

Oral administration  Amoxicillin (1)  2 g p.o.   50 mg/kg p.o.
 Oral administration not possible Ampicillin   2 g i.v.  50 mg/kg i.v.
 Allergy to penicillin or ampicillin – oral administration Clndamycin (2)  600 mg p.o.   20 mg/kg p.o.
 Allergy to penicillin or ampicillin – oral administration not possible Cefazolin (3)   1 g i.v. 50 mg/kg i.v. 

Legend: p.o. = per os (oral administration), i.v. = intravenous (injection into the vein), (1) Alternative: penicillin, (2) Alternative: cephalexin, (3) Alternative: clindamycin or ceftriaxon

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