Endocarditis Prophylactic Regimens for

Oral, Respiratory Tract, or Esophageal Procedures

Standard general prophylaxis
Adults: Amoxicillin 2 grams orally 1 hour before procedure
Children: Amoxicillin 50 mg/kg orally 1 hour before procedure

Unable to take oral medications
Adults: Ampicillin 2 grams IM or IV within 30 min. before procedure
Children: Ampicillin 50 mg/kg IM or IV within 30 min. before procedure

Allergic to penicillin
Adults: Clindamycin 600 mg orally 1 hour before procedure
   Cephalexin or cefadroxil 2 grams orally 1 hour before procedure
   Azithromycin or clarithromycin 500 mg 1 hour before procedure
Children: Clindamycin 20 mg/kg orally 1 hour before procedure
   Cephalexin or cefadroxil 50 mg/kg 1 hour before procedure
   Azithromycin or clarithromycin 15 mg/kg 1 hour before procedure

Allergic to penicillin and unable to take oral medications
Adults: Clindamycin 600mg IV within 30 min before procedure
Cefazolin 1 gram IM or IV within 30 min before procedure
Children: Clindamycin 20 mg/kg IV within 30 min before procedure
Cefazolin 25 mg/kg IM or IV within 30 min before procedure

Prophylactic Regimens for Genitourinary/Gastrointestinal (excluding esophageal) Procedures

High risk patients
Adults: Ampicillin 2 grams IM or IV + gentamicin 1.5 mg/kg
   (not to exceed 120 mg) within 30 min of starting the procedure;
   6 hr later, ampicillin 1 gm IM/IV or amoxicillin 1 gm orally
Children: Ampicillin 50 mg/kg IM/IV (not to exceed 2 gm) + gentamicin
   1.5 mg/kg within 30 min of starting the procedure; 6 hr later,
   ampicillin 25 mg/kg IM/IV or amoxicillin 25 mg/kg orally

High risk patients allergic to ampicillin/amoxicillin
Adults: Vancomycin 1 gm IV over 1-2 hrs + gentamicin 1.5 mg/kg IV/IM
   (not to exceed 120 mg); complete injection/infusion within
   30 min of starting the procedure
Children: Vancomycin 20 mg/kg IV over 1-2 hrs + gentamicin 1.5 mg/kg
   IV/IM; complete dosing within 30 min of starting procedure

Moderate-risk patients
Adults: Amoxicillin 2 gm orally 1 hr before procedure
Ampicillin 2 gm IV/IM within 30 min of starting procedure
Children: Amoxicillin 50 mg/kg orally 1 hr before procedure
Ampicillin 50 mg/kg IM/IV within 30 min of starting procedure

Moderate-risk patients allergic to ampicillin/amoxicillin
Adults: Vancomycin 1 gm IV over 1-2 hrs; complete infusion within 30 min
of starting procedure
Children: Vancomycin 20 mg/kg IV over 1-2 hrs; complete infusion within 30 min
of starting the procedure

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