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PREMEDICATION FOR DENTAL PROCEDURES

Vol. 67 No. 2 A Publication of The New Jersey Dental Association June 1997

Pre-Medication for Dental Procedures
Updated recommendations for Bacterial Endocarditis

A committee that includes American Dental Association representation has updated its recomendations to include oral health treatment of patients at risk for bacterial endocarditis. The recommendations are significant and reflect the first change since 1990.

The following recommendation update was made by the Science Advisory and Coordinating Committee of the American Heart Association:

1. Antibiotics amoxicillin, ampicillin and penicillin V are equally effective in vitro against a-hemolytic streptococci, however amoxicillin is recommended because it is better absorbed from the gastro intestinal tract and provides higher and more sustained serum level. The new dosage recomendation for adults is 2.0g (for pediatric patients, the dosage recomendation is 50mg/kg not to exceed the adult dose) to be administered one hour before the anticipated procedure.

2. A FOLLOW UP ANTIBIOTIC DOSE IS NO LONGER RECOMMENDED.

3. Erythromycin is no longer recommended for penicillin-allergic individuals but clindamycin and other alternatives are offered.

4. "Antibiotics are not recommended for local anesthetic injections, placement of rubber dams, suture removal, taking of oral impressions, fluoride treatment or orthodontic appliance adjustment." AHA recommends antibiotics before dental procedures if bleeding is anticipated, to include tooth extraction, periodontal procedures, dental implants and reimplantation of teeth.

The recommendations were then printed in the June 11, 1997 JOURNAL of the AMERICAN MEDICAL ASSOCIATION(pages 1794-1801). The complete manuscript will appear in a future JADA.

SITUATION	AGENT	REGIMEN*
Standard General Prohylaxis	Amoxycillin	Adults: 2.0g; Children: 50mg/kg orally 1 hour before procedure
Unable to take oral medications	Ampicillin	Adults: 2.0g intermuscularly (IM) or intravenously(IV); Children: 50mg/kg IM or IV within 30 minutes before procedure
Allergic to penicillin	Clindamycin	Adults 600mg: Children: 20mg/kg orally 1 hour before procedure
or	Cephalexin+ or	Adults: 2.0g; Children: cefadroxil+ 50mg/kg orally 1 hour before procedure
or	Azithromycin or clarithromycin	Adults: 500mg; Children: 15mg/kg orally 1 hour before procedure
Allergic to penicillin and unable to take oral medications	Clindamycin	Adults: 600mg; Children 20mg/kg IV within 30 minutes before procedure
or	Cefazolin+	Adults: 1.0g; Children: 25mg/kg IM or IV within 30 minutes before procedure

-Total children's dose should not exceed adult dose +Cephalosporins should not be used in individuals with immediate-type hypersensitivity reaction (urticaria, angioedemia, or anaphylaxis) to penicillins.

Source: American Heart Association