Answer
The most common cause of endocarditis for dental, oral, respiratory tract, or esophageal procedures is S viridans (alpha-hemolytic streptococci). Antibiotic regimens for endocarditis prophylaxis are directed toward S viridans, and the recommended standard prophylactic regimen is a single dose of oral amoxicillin. Amoxicillin, ampicillin, and penicillin V are equally effective in vitro against alpha-hemolytic streptococci; however, amoxicillin is preferred because of superior gastrointestinal absorption that provides higher and more sustained serum levels.
All pediatric doses shown below are administered once as a single dose 30-60 minutes before the procedure.
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Standard general prophylaxis: Amoxicillin 50 mg/kg PO; not to exceed 2 g/dose
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Unable to take oral medication: Ampicillin 50 mg/kg IV/IM; not to exceed 2 g/dose
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Allergic to penicillin: (1) Clindamycin 20 mg/kg PO (not to exceed 600 mg/dose) or (2) cephalexin 50 mg/kg PO (not to exceed 2 g/dose) or other first- or second-generation oral cephalosporin in equivalent dose (do not use cephalosporins in patients with a history of immediate-type hypersensitivity penicillin allergy, such as urticaria, angioedema, anaphylaxis) or (3) azithromycin or clarithromycin 15 mg/kg PO (not to exceed 500 mg/dose)
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Allergic to penicillin and unable to take oral medication: (1) Clindamycin 20 mg/kg IV (not to exceed 600 mg/dose) or (2) cefazolin or ceftriaxone 50 mg/kg IV/IM (not to exceed 1 g/dose) (do not use cephalosporins in patients with a history of immediate-type hypersensitivity penicillin allergy, such as urticaria, angioedema, anaphylaxis)
