Pre-medication Regimens for a dental procedure (Heart):

 

SITUATION                                            

· AGENT                                              

(REGIMEN: SINGLE DOSE 30-60 MINUTES BEFORE PROCEDURE)                                                                          

· Adults                                    

· Children

 

Oral                                                        

· Amoxicillin                         

· 2 grams                             

· 50 milligrams per kilogram

 

Unable to Take Oral Medication                       

· Ampicillin                           

· 2 g IM* or IV       

· 50 mg/kg IM or IV                                               

OR                                                          

· Cefazolin or ceftriaxone                   

· 1 g IM or IV        

· 50 mg/kg IM or IV

                                                               

 

Allergic to Penicillins or Ampicillin Oral                                                        

· Cephalexin                        

· 2 g                     

· 50 mg/kg

OR                                          

· Clindamycin                       

· 600 mg                              

· 20 mg/kg

OR

· Azithromycin or clarithromycin         

· 500 mg                              

· 15 mg/kg                                                            

                                                                                               

Allergic to Penicillins or Ampicillin and Unable to Take Oral Medication                               

Cefazolin or ceftriaxone                   

· 1 g IM or IV        

· 50 mg/kg IM or IV

OR                                                          

· Clindamycin                                                                                                                       

· 600 mg IM or IV 

· 20 mg/kg IM or IV

TABLE 1. PATIENTS AT POTENTIAL INCREASED RISK OF HEMATOGENOUS TOTAL JOINT INFECTION*

  

Immunocompromised/Immunosuppressed Patients

·   Inflammatory arthropathies such as rheumatoid arthritis, systemic lupus erythematosus

·   Drug- or radiation-induced immunosuppression

 

Patients with Comorbidities†

·   Previous prosthetic joint infections

·   Malnourishment

·   Hemophilia

·   HIV infection

·   Insulin-dependent (Type I) diabetes

·   Malignancy

TABLE 2. INCIDENCE STRATIFICATION OF BACTEREMIC DENTAL PROCEDURES*

 

HIGHER INCIDENCE

·   Dental extractions

·   Periodontal procedures including surgery, subgingival placement of antibiotic fibers/strips, scaling and root planing, probing, recall maintenance

·   Dental implant placement and replantation of avulsed teeth

·   Endodontic (root canal) instrumentation or surgery only beyond the apex

·   Initial placement of orthodontic bands but not brackets

·   Intraligamentary and intraosseous local anesthetic injections

·   Prophylactic cleaning of teeth or implants where bleeding is anticipated

 

LOWER INCIDENCE

·   Restorative dentistry (operative and prosthodontic) with or without retraction cord**

·   Local anesthetic injections (non intraligamentary and non intraosseous)

·   Intracanal endodontic treatment; post placement and buildup

·   Placement of rubber dam

·   Postoperative suture removal

·   Placement of removable prosthodontic/orthodontic appliances

·   Taking of oral impressions

·   Fluoride treatments

·   Taking of oral radiographs

·   Orthodontic appliance adjustment

*No second doses are recommended for any of these dosing regimens.