Endocarditis Prophylaxis
- The AHA and Australian guidelines limit prophylaxis to dental procedures in patients at highest cardiac risk.
- Dental procedures include gingival manipulation, periapical manipulation or perforation of oral mucosa.
- Dental extractions, implant placement and scaling are high risk procedures in Australian guidance.
- Prophylaxis is not recommended before gastrointestinal or genitourinary procedures.
- Prophylaxis is not recommended for orthopaedic surgery or joint replacement.
- AAOS and ADA found insufficient evidence for routine antibiotics before dental procedures in joint replacement patients.
- Highest risk conditions include prosthetic cardiac valves, including transcatheter valves.
- Prosthetic material used for valve repair, such as annuloplasty rings, is highest risk.
- Ventricular assist devices are highest risk.
- Previous infective endocarditis is highest risk.
- Unrepaired cyanotic congenital heart disease, including palliative shunts and conduits, is highest risk.
- Repaired congenital defects with residual defects next to prosthetic material are highest risk.
- Completely repaired defects with prosthetic material carry risk for the first six months.
- Cardiac transplant recipients who develop valvulopathy are highest risk in the AHA statement.
- Australian guidance also includes rheumatic heart disease.
- Oral amoxicillin 2 g given 60 minutes before the procedure is the preferred Australian regimen.
- Cefalexin 2 g or doxycycline 100 mg are alternatives in penicillin allergy. Clindamycin is avoided in the AHA statement.
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 12 October 2026.