Reference: Circulation. 1997;96:358-366
Standard general prophylaxis
Amoxicillin Adults: 2.0 g; children: 50 mg/kg orally 1 h before procedure
Unable to take oral medications
Ampicillin Adults: 2.0 g IM or IV; children: 50 mg/kg IM or IV within 30 min before procedure
Allergic to penicillin Clindamycin Adults: 600 mg; children: 20 mg/kg orally 1 h before procedure
or
Cephalexin2 or cefadroxil2
Adults: 2.0 g; children; 50 mg/kg orally 1 h before procedure
or
Azithromycin or clarithromycin
Adults: 500 mg; children: 15 mg/kg orally 1 h before procedure
Allergic to penicillin and unable to take oral medications
Clindamycin
Adults: 600 mg; children: 20 mg/kg IV within 30 min before procedure or
Cefazolin2
Adults: 1.0 g; children: 25 mg/kg IM or IV within 30 min before procedure
IM indicates intramuscularly, and IV, intravenously.
1 Total children's dose should not exceed adult dose.
2 Cephalosporins should not be used in individuals with immediate-type hypersensitivity reaction (urticaria, angioedema, or anaphylaxis) to penicillins.
High-risk patients
Ampicillin plus gentamicin
Adults: ampicillin 2.0 g IM or IV plus gentamicin 1.5 mg/kg (not to exceed 120 mg) within 30 min of starting procedure; 6 h later, ampicillin 1 g IM/IV or amoxicillin 1 g orally
Children: ampicillin 50 mg/kg IM or IV (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: vancomycin 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 procedure
Children: vancomycin 20 mg/kg IV over 1-2 h plus gentamicin 1.5 mg/kg IV/IM; complete injection/infusion within 30 min of starting 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 procedure
Children: amoxicillin 50 mg/kg orally 1 h before procedure, or ampicillin 50 mg/kg IM/IV within 30 min of starting procedure
Moderate-risk patients allergic to ampicillin/amoxicillin
Vancomycin Adults: vancomycin 1.0 g IV over 1-2 h complete infusion within 30 min of starting procedure
Children: vancomycin 20 mg/kg IV over 1-2 h; complete infusion within 30 min of starting procedure
IM indicates intramuscularly, and IV, intravenously.
1 Total children's dose should not exceed adult dose.
2 No second dose of vancomycin or gentamicin is recommended.