Which cardiac conditions does the AHA list for premedication?

Infective Endocarditis Prophylaxis

The AHA and the ACC recommends AP for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from IE, such as those with a prosthetic heart valve, a past history of IE, unrepaired cyanotic congenital heart disease, residual shunt adjacent to prosthetic material, and cardiac valvulopathy following cardiac transplantation [23, 24]. AP is recommended for all dental procedures that involve manipulation of either gingival tissue or the periapical region of teeth or perforation of oral mucosa in these high-risk patients [23, 24]. Antibiotic choice depends on administration route and a patient’s allergies. Notably, if there has been a reaction i.e. urticaria or anaphylaxis with a penicillin derivative, cephalosporins should not be given. 500 mg of oral azithromycin or clarithromycin are good alternatives in these cases. 100 mg of doxycycline is also acceptable. [23, 25] For optimal effect, antibiotic prophylaxis should be administered 30–60 min prior to the procedure. When oral medications can be given, 2gm of Amoxicillin is considered the gold standard. IV/IM alternatives include Ampicillin 2gm or Cefazolin 1gm (Table 1). [25]

Endocarditis in Adult Congenital Heart Disease Patients: Prevention, Recognition, and Management. © The Author(s) 2024, corrected publication 2025. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).