Regime

Dental treatment under local anaesthesia or without local anaesthesia

Class III: Low Risk of Developing Infective Endocarditis

No Antimicrobial Prophylaxis Required

Special Considerations:

Multiple Visits for Treatment Using Local (or no) Anaesthesia

For a care plan that will require several visits then a period of 1 month should elapse before the second dose of the same antibiotic. If treatment is planned to extend over more than two visits then Amoxicillin should be used one visit and Clindamycin (or Clarithromycin) for the next visit. This alternating sequence can be continued until treatment is complete and the time interval between different types of antibiotics does not need to exceed one month.

For Those at Highest Risk of IE eg: Patients with Prosthetic Heart Valves or Previous IE

Adults— Intravenous Amoxicillin 2g within 30 mins before the procedure

Plus Intravenous Gentamicin 1.5mg/kg within the same time period,

Followed post-operatively by Intravenous Amoxicillin 1g

Or Oral Amoxicillin 1g 6 hours post procedure

Children < 5 years as for < 10 years

< 10 years Intravenous Amoxicillin 1g within 30 mins before the procedure

Plus Intravenous Gentamicin 1.5mg/kg within the same period

Followed post-operatively by Oral Amoxicillin at 6 hours post procedure

For Patients Allergic to Penicillin

Adults—Intravenous Vancomycin 1g infused over the 2 hours before the procedure

Plus Intravenous Gentamicin 1.5mg/kg within the same time period

Children < 5 years as for < 10 years

< 10 years Intravenous Vancomycin 20mg/kg over the 2 hours before the procedure

Plus Intravenous Gentamicin 1.5mg/kg within the same time period

> 10 years, use adult dose

Class I: High Risk of Developing Infective Endocarditis

Class II: Moderate Risk of Developing Infective Endocarditis

GA and Sedation Protocol

Patients at Risk

Procedures requiring ABC

Clinical Situation	Drug	Regime
Patients not allergic to Penicillin or Patients who have not received more than a single dose or course of penicillin in the previous month	Amoxicillin	Adults Oral Amoxicillin 3g administered 1 hour before the procedure Children <5 years: Oral Amoxicillin 250mg administered 1 hour before procedure 5-10 years: Oral Amoxicillin 500mg administered 1 hour before the procedure >10 years: use adult dose
Patients allergic to Penicillin or who have had more than a single dose or course of Penicillin (or other Beta Lactam antibiotic) within the last month	Clindamycin	Adults Oral Clindamycin 600mg 1 hour before procedure Children <5 years: Oral Clindamycin 150mg administered 1 hour before procedure 5-10 years: Oral Clindamycin 300mg administered 1 hour before the procedure >10 years: use adult dose
[The oral suspension of Clindamycin is no longer available in the United Kingdom. If children are unwilling or unable to swallow tablets or capsules, or patients are suffering with dysphagia, then Azithromycin is a suitable alternative.]	Azithromycin	Adults 500mg administered 1 hour before the procedure Children <5 years: Oral Azithromycin 200mg administered 1 hour before procedure 5-10 years: Oral Azithromycin 300mg administered 1 hour before procedure >10 years: use adult dose of 500mg 1 hour before procedure.