Antibiotic Premedication for Dental Treatment

Antibiotic prophylaxis is the administration of antibiotics to patients without the evidence of infection to prevent bacterial colonization and reduce subsequent postoperative or post- treatment complications.

The main indication for antibiotic prophylaxis for dental patients is the prevention of infective Endocarditis (IE). This is limited to specific patients receiving specified dental treatments. There is still a great deal of controversy whether dental patients with orthopedic prosthetic devices (joint replacement), indwelling catheters and immune suppressed patients require prophylaxis.

The medical conditions for which Endocarditis prophylaxis is recommended:

a. Unrepaired cyanotic CHD, including palliative shunts or conduits

b. Completely repaired congenital heart defects with prosthetic material or device,

whether placed by surgery or by catheter intervention during the first six months

after placement of the material or device.

c. Repaired CHD with residual defects at, or adjacent to, the site of a prosthetic

patch or prosthetic device.

a. Patient already receiving antibiotics – If the patient is taking an antibiotic normally used for Endocarditis prophylaxis it is best to select an antibiotic from a different class rather than increase the dose of the antibiotic they are currently taking. Ideally if the dental procedure can be delayed at least 10 days after the completion of the antibiotic is the best case, though this may not always be possible.

b. Failure to administer pretreatment antibiotic dose – this can be given up to 2 hours after the procedure.

c. Individuals with kidney dialysis shunts – With permanent kidney dialysis shunts prophylaxis for IE should be followed.

Dental Procedures for which antibiotic prophylaxis should be used: Dental Extractions

Periodontal procedures including surgery, scaling and root planning, recall maintenance, subgingival placement of materials

Patients with total joint replacement who should receive prophylaxis:

All patients during the first two years following joint replacement

Immunocompromised/immunosuppressed patients – these include patients with inflammatory diseases and drug or radiation – induced immunosuppression

Patient with comorbidities ( this is some of the conditions, there may be others) such as malnourishment, hemophilia, HIV infection, Type I diabetes, malignancy

The recommended regimen for antibiotic prophylaxis is given one hour prior to dental procedures.

A. For patients not allergic to penicillin 2 grams (2,000mg) of amoxicillin, cephalexin or cephradine is given orally.

B. If the patient is not allergic to penicillin and is unable to take oral medication 1 gram (1,000mg) cefazolin or 2 grams (2,000mg) ampicillin can be given IM or IV. This would be arranged through the patients’ primary care physician.

C. If the patient is allergic to penicillin 600mg of clindamycin is given orally.

D. If the patient is allergic to penicillin and is unable to take oral medications 600mg.

clindamycin can be given IV. This would have to be arranged through the patients’ primary care physician.

If you have any questions about whether you require pre-medication prior to your dental appointment please call Dr. Semashko’s office and this will be discussed with you.

As protocols continue to change the latest information will be available to you on Dr. Semashko’s website.

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