Reference

Dajani, et. al, "Prevention of Bacterial Endocarditis: Recommendations By The American Heart Association" JAMA, June 11, 1997 (Vol. 277, no. 22).

"There are currently no randomized and carefully controlled human trials in patients with underlying structural heart disease to definitively establish that antibiotic prophylaxis provides protection against development of endocarditis during bacteremia-inducing procedures." p. 1794

Prophylaxis Regimens for GU, GI (Excluding Esophageal) Procedures

Prophylaxis Regimens for Oral, Dental, Respiratory Tract, or Esophageal Procedures

Cardiac Conditions Associated With Endocarditis

Endocarditis Prophylaxis Recommended

High-risk category

Prosthetic cardiac valves, including bioprosthetic and homograft valves
Previous bacterial endocarditis
Complex cyanotic congenital heart disease (e.g. single ventricle states, transposition, Tets)
Surgically constructed systemic pulmonary shunts and conduits

Moderate Risk Category

Most other congenital cardiac malformations (other than above and below)
Acquired valvar dysfunction (e.g. rheumatic heart disease)
Hypertrophic cardiomyopathy

Endocarditis Prophylaxis NOT Recommended

Negligible-risk category (no greater risk than general population)

Isolated secundum atrial septal defect
Surgical repair of ASD, VSD, or PDA
Mitral Valve Prolapse without valvar regurgitation
Physiologic, functional, or innocent heart murmurs
Previous Kawasaki disease without valvar dysfunction
Previous rheumatic fever without valvar dysfunction
Cardiac pacemakers and implanted defibrilators

Procedures And Endocarditis Prophylaxis

Endocarditis Prophylaxis Recommended

Respiratory Tract

Tonsillectomy and/or adenoidectomy
Surgical operations that involve respiratory mucosa
Bronchoscopy with rigid bronchoscopes

Sclerotherapy for esophageal varices
Esophageal structure dilation
ERCP for biliary obstruction
Biliary tract surgery
Surgical operations that involve intestinal mucosa

Prostatic surgery
Cystoscopy
Urethral dilation

Endocarditis Prophylaxis NOT recommended

Respiratory Tract

Endotracheal intubation
Bronchoscopy with a flexible bronchoscope with or without biopsy (optional for high risk patients)
Tympanostomy tube insertion

Gastrointestinal Tract

TEE (optional for high risk patients)
Endoscopy with or without gastrointestinal biopsy (optional for high risk patients)

Genitourinary Tract

Vaginal hysterectomy (optional for high risk patients)
Vaginal delivery (optional for high risk patients)
Cesarean section
In uninfected tissue: urethral cath, uterine D&C, TAB, sterilization procedure, insertion or removal of IUD

Cardiac cath, including balloon angioplasty Implanted cardiac pacemakers, defibrilators, or coronary stents
Incision or biopsy of surgically scrubbed skin
Circumcision