Dental procedures endocarditis prophylaxis

The goal of antimicrobial prophylaxis in dental procedures is to prevent endocarditis. According to American Heart Association guidelines, at-risk individuals should receive 2 g of amoxicillin 1 hour prior to the procedure.23 Patients with a (5-lactam allergy may receive clindamycin 600 mg 1 hour prior to the procedure. Interested readers should refer to the American Heart Association guidelines for a complete discussion on risk stratification and recommendations. 

Cardiac Conditions Associated with the Highest Risk of Adverse Outcome from Endocarditis for Which Prophylaxis with Dental Procedures Is Recommended... 

Endocarditis prophylaxis is recommended for all dental procedures that involve manipulation of the gingival tissue of the periapical region of teeth or perforation of the oral mucosa. 

Clindamycin is indicated for the treatment of skin and soft-tissue infections caused by streptococci and staphylococci. It is often active against community-acquired strains of methicillin-resistant S aureus, an increasingly common cause of skin and soft tissue infections. Clindamycin is also indicated for treatment of anaerobic infection caused by bacteroides and other anaerobes that often participate in mixed infections. Clindamycin, sometimes in combination with an aminoglycoside or cephalosporin, is used to treat penetrating wounds of the abdomen and the gut infections originating in the female genital tract, eg, septic abortion and pelvic abscesses and aspiration pneumonia. Clindamycin is now recommended rather than erythromycin for prophylaxis of endocarditis in patients with valvular heart disease who are undergoing certain dental procedures. Clindamycin plus primaquine is an effective alternative to trimethoprim-sulfamethoxazole for moderate to moderately severe Pneumocystis jiroveci pneumonia in AIDS patients. It is also used in combination with pyrimethamine for AIDS-related toxoplasmosis of the brain. 

Vancomycin (500 mg IV q. 6 hours) is indicated for the treatment of severe staphylococcal infections, when other antibiotics are ineffective or contraindicated. Vancomycin (125 to 500 mg p.o. q. 6 hours for 7 to 10 days) is indicated for the treatment of antibiotic-associated pseudomembranous and staphylococcal enterocolitis and vancomycin (1 g IV given slowly over 1 hour, starting 1 hour before a procedure) is indicated for endocarditis prophylaxis for dental, Gl, biliary, and genitourinary instrumentation procedures and... 

Prior to 1997, erythromycin was an alternative antibiotic choice to amoxicillin for prophylaxis prior to dental, oral, esophageal, and respiratory procedures to prevent infective endocarditis (IE). Erythromycin is an alternative choice for treating a recurrence of acute rheumatic fever in patients allergic to penicillin [12]. Recently updated recommendations by the American Heart Association for IE... 

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