Dental Procedures Prophylaxis in Patients at Risk



Dental Procedures Prophylaxis in Patients at Risk







  • Evaluation



    • General—dental work causes transient bacteremia that may result in endocarditis in at-risk patients.


    • Etiology—the most common cause of endocarditis postdental procedure is Streptococcus viridans.



    • Cardiac conditions associated with endocarditis



      • High/moderate risk



        • Prosthetic heart valve


        • Acquired heart valve dysfunction (e.g., because of rheumatic heart disease)


        • Mitral valve prolapse with mitral regurgitation and/or thickened leaflets


        • Previous history of bacterial endocarditis


        • Surgically made pulmonary shunts or conduits


        • Congenital heart disease (e.g., tetralogy of Fallot, etc.)


        • Hypertrophic cardiomyopathy


    • Dental procedures for which antibiotic prophylaxis is recommended in at-risk patients.



      • Periodontal procedures


      • Dental extractions


      • Dental implant placement


      • Dental cleaning of teeth or implants where bleeding is expected


      • Endodontic instrumentation (root canal)


      • Intraligamentary local anesthetic injections


      • Placement of orthodontic bands


      • Subgingival placement of antibiotic fibers/strips


    • Prophylactic regimens (see Table 2.20.1)



REMEMBER:

Up to 10% of patients with a penicillin allergy have an adverse reaction to cephalosporins.








TABLE 2.20.1 Prophylactic Regimens



































Standard

Amoxicillin 2 g PO 1 hr before procedure


Unable to take PO

Ampicillin 2 g IM/IV 30-min before procedure


Penicillin allergy

Clindamycin (Cleocin) 600 mg PO 1 hr before procedure

or clindamycin (Cleocin) 600 mg IV 30-min before procedure

OR

Azithromycin (Zithromax) 500 mg PO 1 hr before procedure

or clarithromycin (Biaxin) 500 mg PO 1 hr before procedure

OR

Cephalexin (Keflex) 2 g PO 1 hr before procedure

or Cefazolin (Ancef) 1 g IV 30 min before procedure


Adapted from Dajani AS, Taubert KA, Wilson W, et al. Prevention of bacterial endocarditis: Recommendations by the American Heart Association. Clin Infect Dis. 1997;25:1448-1458.

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Aug 28, 2016 | Posted by in PSYCHIATRY | Comments Off on Dental Procedures Prophylaxis in Patients at Risk

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