Valvular Heart Disease
Recommended Standard Prophylactic Regimes for Dental, Oral,
Respiratory Tract, or Esophageal Procedures
Standard general prophylaxis
Amoxicillin
Adults: 2.0 g; children: 50 mg/kg orally 1h before procedure-unable
to take oral medications
Ampicillin
Adults: 2.0 g intramuscularly (IM) or intravenously (IV); children:
50 mg/kg IM or IV within 30 min. before procedureAllergic to penicillin
Clindamycin
Adults: 600 mg; children: 20 mg/kg orally 1h before procedure
or
Cephalexin** or cefadroxil**
Adults: 2.0g; children: 50 mg/kg orally 1h before procedure
or
Azithromycin or clarithromycin
Adults: 500 mg; children: 15 mg/kg orally 1 h before procedureAllergic
to penicillin and unable to take oral medications
Clindamycin
Adults: 600 mg; children: 20 mg/kg IV within 30 minutes
before procedure
or
Cefazolin**
Adults: 1.0 g; children: 25 mg/kg IM or IV within 30 min
before procedure
Prophylactic Regimens for Genitourinary Gastrointestinal (Excluding
Esophageal) Procedures
High Risk Patients
Ampicillin plus Gentamicin
Adults: ampicillin 2.0 g intramuscularly (IM) or intravenously
(IV) plus gentamicin 1.5 mg/kg (not to exceed 120 mg (within 30 min of
starting the procedure; 6 h later, ampicillin 1 g IM/IV or amoxicillin
1 g orally
Children: ampicillin 50 mg/kg IV or IM (not to exceed 2.0 g) plus
gentamicin 1.5 mg/kg within 30 min of starting the procedure; 6 h later,
ampicillin 25 mg/kg IM/IV or amoxicillin 25 mg/kg orally
High-risk patients allergic to ampicillin/amoxicillin
Vancomycin plus Gentamicin
Adults: vancolmycin 1.0 g IV over 1-2 h plus gentamicin 1.5 mg/kg
IV/IM (not to exceed 120 mg); complete injection/infusion within 30 min
of starting the procedure.
Children: vancolmycin 20 mg/kg IV over 1-2 h plus gentamicin 1.5
mg/kg IV/IM; complete injection/infusion within 30 min of starting the
procedure.
Moderate-risk patients
Amoxicillin or Ampicillin
Adults: amoxicillin 2.0 g orally 1 h before procedure, or ampicillin
2.0 g IM/IV within 30 min of starting the procedure
Children: amoxicillin 50 mg/kg orally 1 h before procedure, or
ampicillin 50 mg/kg IM/IV within 30 min of starting the procedure
Moderate-risk patients allergic to amicillin/amoxicillin
Vancomycin
Adults: vancomycin 1.0 g IV over 1-2 h; complete infusion within
30 min of starting the procedure
Children: vancomycin 20 mg/kg IV over 1-2 h; complete infusion
within 30 min of starting the procedure
_____________________________
* Total children’s dose should not exceed adult dose.
** No second dose of vancomycin or gentamicin is recommended.
NOTE: In patients with significantly compromised renal function, antibiotic
dosages may need to be modified. Intramuscular injections may be contraindicated
in patients receiving anticoagulants.
Adapted from: JAMA 1997; 277(22): 1794-1801
Please refer to the original report for more complete information as to
which patients and procedures require prophlaxis, as well as appropriate
doses for children. Children’s antibiotic dosages should not exceed
the maximum adult doses.
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