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ANTIBIOTIC GUIDELINES FOR
Many of you take an antibiotic prior to dental treatment. The purpose is to use an antibiotic prior to an infection to prevent an infection. It may be because of a mitral valve prolapse, certain types of implants, a joint replacement, or a heart murmur cause by a roughened heart valve. Antibiotic prophylaxis began initially to prevent bacterial endocarditis. Endocarditis is the collection and colonization of bacteria in the heart muscle. This leads to inflammation and deformation of the heart and is a life-threatening condition.
The American Heart Association published its first guidelines in 1955. Since then the guidelines have been modified several times. Each revision has tried to make the antibiotic regime simpler to increase patient compliance. The revisions also attempt to consider the fact that many bacteria present can eventually become resistant to the antibiotic therapy.
The guidelines for antibiotic prophylaxis was updated in 1990 and most recently in 1997. Before we review the most recent guidelines, as they relate to dentistry, please remember this. The original decision to use antibiotics to prevent infection was based on the assumption that if antibiotics are effective in treating an infection, they should be able to prevent them. Any studies to support this premise were done strictly in the laboratory and the primary mechanism for the prevention of endocarditis is not known.
The AHA guidelines are followed by most practitioners, but it is not unusual to find certain changes in dosages or medications made by particular doctors.
Antibiotic prophylaxis is recommended for the following:
Negligible-risk category (no greater risk than the general population)
|Standard prophylaxis||Amoxicillin||Adults: 2.0 g; children: 50 mg/kg orally 1 h before procedure|
|Unable to take oral medication||Ampicillin||Adults: 2.0 g IM or IV; children: 50 mg/kg IM or IV within 30 min before procedure|
|Allergic to Penicillin||Clindamycin or||Adults: 600 mg; children: 20 mg/kg orally 1 h before procedure|
|Cephalexin or cefadroxil or||Adults: 2.0 g; children; 50 mg/kg orally 1 h before procedure|
|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
Z-pak -once a day
|Adults: 600 mg; children: 20 mg/kg IV within 30 min before procedure Adults: 1.0 g; children: 25 mg/kg IM or IV within 30 min before procedure|
Alert: Allergic reactions to antibiotics may be treated with benadryl and pepcid.
A complete listing of recommended procedures can be found at the American Heart Association website.
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