Cardiac conditions associated with endocarditis
High-risk category
Moderate-risk category

Prosthetic cardiacs valves, including bioprosthetic and homograft valves

Previous bacterial endocarditis

Complex cyanotic congenital heart disease (single ventricle states, TOF, transposition of the great arteries)

Surgically constructed systemic pulmonary shunts or conduits

Most other congenital cardiac malformations (other than mentioned at left)

Acquired valvar dysfunction (e.g., rheumatic heart disease)

Hypertrophic cardiomyopathy

Mitral valve prolapse with valvar regurgitation and/or thickened leaflets


Recommended prophylactic regimens
Dental procedures (all patients)

Dental extractions

Periodontal procedures including surgery, scaling, and root planing, probing, and recall maintenance

Dental and denture implants

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

Subgingival placement of antibiotic fibers or strips

Initial placement of orthodontic bands but not brackets

Intraligamentary local anesthetic injections

Prophylactic cleaning of teeth or implants where bleeding is anticipated

Other procedures
Respiratory tract

Tonsillectomy and/or adenoidectomy

Surgical operations that inolve respiratory mucosa

Bronchoscopy with a rigid bronchoscope
Gastrointestinal tract 1

Sclerotherapy for esophageal varices

Esophageal stricture dilatation

Endoscopic retrograde cholangiography with biliary obstruction

Biliary tract surgery

Surgical operations that involve intestinal mucosa

Genitourinary tract

Prostatic surgery


Urethral dilation

1 For high-risk patients; optional for medium-risk patients


Prophylactic regimens for dental, oral, respiratory tract or esophageal procedures (follow-up dose no longer recommended)

Amoxicillin: 2.0g PO, 1h before procedure or

Ampicillin 2.0g IM ou IV, 30min before procedure


Clindamycin: 600mg PO 1h before or

Cephalexin or Cefadroxil 2.0g PO 1h before or

Azithromycin or Clarithromycin 500mg PO 1h before or

Clindamycin 600mg IV, 30min before or

Cefazolin 1g IM or IV 30min before


Prophylactic regimens for genitourinary/gastrointestinal procedures
High-risk patients
Moderate-risk patients

Ampicillin2.0g+Gentamicin 1.5mg/kg (max 120mg) IM or IV 30min before

6h later: ampicillin 1g IM or IV or amoxicillin 1g PO



Vancomicin 1g IV over 1-2h & Gentamicin 1.5mg/kg (max 120mg) IM or IV.

Complete injection or infusion within 30min before starting procedure


Amoxicillin 2g PO 1h before procedure or

Ampicillin 2g IM or IV 30min before procedure



Vancomycin 1g IV Complete infusion within 30 min of starting the procedure



NOTE: for patients already taking an antibiotic, or for other special situations, please refer to the full statement referenced below.

JAMA 1997, 277:1794-1801, Circulation 1997, 96:358-366, and JADA 1997, 128:1142-1150