Reference: Circulation. 1997;96:358-366
Endocarditis prophylaxis recommended1
Dental extractions
Periodontal procedures including surgery, scaling and root planing, probing, and recall maintenance
Dental implant placement and reimplantation of avulsed teeth
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
Endocarditis prophylaxis not recommended
Restorative dentistry 2 (operative and prosthodontic) with or without retraction cord 3
Local anesthetic injections (nonintraligamentary)
Intracanal endodontic treatment; post placement and buildup
Placement of rubber dams
Postoperative suture removal
Placement of removable prosthodontic or orthodontic appliances
Taking of oral impressions
Fluoride treatments
Taking of oral radiographs
Orthodontic appliance adjustment
Shedding of primary teeth
1 Prophylaxis is recommended for patients with high- and moderate-risk cardiac conditions.
2 This includes restoration of decayed teeth (filling cavities) and replacement of missing teeth.
3 Clinical judgment may indicate antibiotic use in selected circumstances that may create significant bleeding.
Endocarditis prophylaxis recommended
Respiratory tract
Tonsillectomy and/or adenoidectomy
Surgical operations that involve respiratory mucosa
Bronchoscopy with a rigid bronchoscope
Gastrointestinal tract 1
Sclerotherapy for esophageal varices
Esophageal stricture dilation
Endoscopic retrograde cholangiography with biliary obstruction
Biliary tract surgery
Surgical operations that involve intestinal mucosa
Genitourinary tract
Prostatic surgery
Cystoscopy
Urethral dilation
Endocarditis prophylaxis not recommended
Respiratory tract
Endotracheal intubation
Bronchoscopy with a flexible bronchoscope, with or without biopsy 2
Tympanostomy tube insertion
Gastrointestinal tract
Transesophageal echocardiography 2
Endoscopy with or without gastrointestinal biopsy 2
Genitourinary tract
Vaginal hysterectomy 2
Vaginal delivery 2
Cesarean section
In uninfected tissue:
Urethral catheterization
Uterine dilatation and curettage
Therapeutic abortion
Sterilization procedures
Insertion or removal of intrauterine devices
Other
Cardiac catheterization, including balloon angioplasty
Implanted cardiac pacemakers, implanted defibrillators, and coronary stents
Incision or biopsy of surgically scrubbed skin
Circumcision
1 Prophylaxis is recommended for high-risk patients; it is optional for medium-risk patients.
2 Prophylaxis is optional for high-risk patients.