American Heart Association Updated Prevention of Infective Endocarditis Guide

The American Heart Association has updated their recommendations regarding Antibiotic Prophylaxis for Infective Endocarditis. No changes have been made regarding which dental procedures need prophylactic coverage.

Current Dental Procedures Requiring Antibiotic Prophylaxis:

  1. Manipulation of the gingival tissues– Any type of Dental Cleanings, gum surgeries, and even deeper fillings that approximate the gum tissue
  2. Manipulation of the periapical region of teeth– Root canals, tooth extractions, and associated treatments
  3. Perforation of the oral mucosa–not including injecting dental anesthetics through non-infected tissue.

Conditions/Diseases that Required Antibiotic Prophylaxis:

  • Prosthetic cardiac valves, including transcatheter-implanted prostheses and homografts
  • Prosthetic material used for cardiac valve repair, such as annuloplasty rings, chords or clips
  • Previous Infective Endocarditis
  • Unrepaired cyanotic congenital heart defect (CHD) or repaired CHD, with residual shunts or valvular regurgitation at the site of or adjacent to the site of a prosthetic patch or prosthetic device
  • Cardiac transplant with valve regurgitation due to a structurally abnormal valve

Updated Antibiotic Prophylactic Regimens:

*Clindamycin is no longer recommended for antibiotic prophylaxis for a dental procedure*

*Single Dose of Antibiotics 30-60 minutes before procedure from the list below*

  1. No Penicillin Allergy:
    • 2g of Amoxicillin for adults or 50mg/kg for children.
  2. Allergic to Penicillin:
    • 2g of Cephalexin for adults or 50mg/kg for children or;
    • 500mg of Azithromycin/Clarithromycin or 15mg/kg for children or;
    • 100mg of Doxycycline for adults
  3. Unable to take Oral Medication:
    • 2g of Ampicillin for adults or 50mg/kg for children IM/IV or;
    • 1g of Cefazolin/Ceftriaxone or 50mg/kg for children IM/IV.
  4. Allergic to Amoxicillin and Unable to take Oral medications:
    • 1g of Cefazolin/Ceftriaxone or 50mg/kg for children IM/IV.

Review these Recommendations and again note that Clindamycin has been removed as a recommended Antibiotic for IE prophylaxis1,2.


  1. Prevention of Viridans Group Streptococcal Infective Endocarditis: A Scientific Statement From the American Heart Association. Circulation. 2021;143:e•••–e•••. Accessible at
  2. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143:e72-e227. Accessible at

The Author of this post does not assume any liability for any injury and/or damage to persons or property as a matter of products liability, malpractice, negligence, or otherwise, or from any use or operation of any methods, instructions or ideas contained. The foregoing parties will not be liable for any direct, special, indirect, incidental, consequential, or punitive damages as a result of the reader’s use of this information.

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