Antibiotic Prophylactic Regimens for EndocarditisExplanation:The antibiotic prophylactic regimens below are recommended by the American Heail Association (AHA) only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditisHigh-Risk Cardiac ConditionsAntibiotic prophylaxis is indicated for the following high-risk cardiac conditions:Prosthetic cardiac valveHistory of infective endocarditisCongenital heart disease (CHD) {except for the conditions listed, antibiotic prophylaxis is no longer recommended for any other form of CHD)Unrepaired cyanotic CHD, including palliative shunts and conduits;Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure; and (3) Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibits endothelialization)Cardiac transplantation recipients with cardiac valvular diseaseDental ProceduresFor patients with high cardiac risk, antibiotic prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa.The following dental procedures do not require endocarditis prophylaxis:Routine anesthetic injections through noninfected tissueTaking dental radiographsPlacement of removable prosthodontic or orthodontic appliancesAdjustment of orthodontic appliancesPlacement of orthodontic bracketsShedding of deciduous teethBleeding from trauma to the lips or oral mucosaRespiratory Tract. Infected Skin, Skin Structures, or Musculoskeletal Tissue ProceduresAntibiotic prophylaxis is recommended forInvasive respiratory tract procedures that involve incision or biopsy of the respiratory mucosa (eg, tonsillecto my, adenoidectomy).Antibiotic prophylaxis is not recommended torBronchoscopy unless the procedure involves Incision of the respiratory tract mucosa.For invasive respiratory tract procedures to treat an established infection (eg, drainage of abscess, empyema), administer an antibiotic that is active against Streptococcus viridans.Patients with high cardiac risk who undergo a surgical procedure that involves infected skin, skin structure, or musculoskeletal tissue should receive an agent active against staphylococci and beta-hemolytic streptococci (eg. anti staphylococcal penicillin, cephalosporin).If the causative organism of respiratory, skin, skin structure, or musculoskeletal infection is known or suspected to be Staphylococcus aureus. administer an antistaphylococcal penicillin or cephalosporin, or vancomycin (if patient is unable to tolerate beta-lactam antibiotics).Vancomycin is recommended for known or suspected methicillin-resistant strains of S aureus.Genitourinary or GI Tract ProceduresAntibiotics are no longer recommended for endocarditis prophylaxis for patients undergoing genitourinary or gastrointestinal tract procedures.All doses shown below are administered once as a single dose 30-60 min before the procedure.Standard general prophylaxisAmoxicillinAdult dose: 2 g POPediatric dose: 50 mg/kg PO; not to exceed 2 g/ doseUnable to take oral medicationAmpicillinAdult dose: 2 g IV7IMPediatric dose: 50 mg/kg IV/IM; not to exceed 2 g/doseAllergic to penicillinClindamycinAdult dose: 600 mg POPediatric dose: 20 mg/kg PO: not to exceed 600 mg/doseAllergic to penicillinCephalexin or other first- or second-generation oral cephalosporin in equivalent dose (do not use cephalosporins in patients with a history of immediate-type hypersensitivity penicillin allergy, such as urticaria, angioedema, anaphylaxis)Adult dose: 2 g POPediatric dose: 50 mg/kg PO; not to exceed 2 g/ doseAzithromycin or clarithromycinAdult dose: 500 mg POPediatric dose: 15 mg/kg PO: not to exceed 500 mg/doseAllergic to penicillin and unable to take oral medicationClindamycinAdult dose: 600 mg IVPediatric dose: 20 mg/kg IV; not to exceed 600 mg/doseCefazolin or ceftriaxone (do not use cephalosporins in patients with a history ofimmediate-type hypersensitivity penicillin allergy, such as urticaria, angioedema, anaphylaxis)Adult dose: I g IV/IMPediatric dose: 50 mg/kg IV/IM; not to exceed 1 g/dose">