Antibiotic Pre-Medication Guidelines for Dental Procedures Antibiotic Pre-Medication Guidelines for Dental Procedures (For Prevention of Infective Endocarditis) (For Prevention of Infective Endocarditis) Guidelines from the American Heart Association – Published April 2007 Guidelines from the American Heart Association – Published April 2007 Introduction Introduction
On April 19, 2007 the American Heart Association released new guidelines for heart patients
On April 19, 2007 the American Heart Association released new guidelines for heart patients
regarding the use of antibiotics before dental procedures. After an extensive review of scientific
regarding the use of antibiotics before dental procedures. After an extensive review of scientific
literature from 1950 to 2006, the AHA’s Endocarditis Committee and experts found that only an
literature from 1950 to 2006, the AHA’s Endocarditis Committee and experts found that only an
exceedingly smal number of cases (if any) of infective endocarditis (IE), also known as bacterial
exceedingly smal number of cases (if any) of infective endocarditis (IE), also known as bacterial
endocarditis (BE), might be prevented by antibiotic prophylaxis prior to a dental procedure.
endocarditis (BE), might be prevented by antibiotic prophylaxis prior to a dental procedure.
Based upon these findings, the current practice of giving patients antibiotics prior to a dental
Based upon these findings, the current practice of giving patients antibiotics prior to a dental
procedure is no longer recommended EXCEPT for patients with the highest risk of adverse outcomes
procedure is no longer recommended EXCEPT for patients with the highest risk of adverse outcomes
resulting from BE (see the table below).
resulting from BE (see the table below).
The following are the new guidelines as published in the American Heart Association’s article and
The following are the new guidelines as published in the American Heart Association’s article and
the new AHA’s Prevention of Bacterial Endocarditis wallet card.
the new AHA Prevention of Bacterial Endocarditis wal et card.
New Guidelines New Guidelines Patients No Longer Needing Patients Still Recommended Patients No Longer Needing Patients Still Recommended To Take Antibiotic Pre-Medication To Take Antibiotic Pre-Medication To Take Antibiotic Pre-Medication To Take Antibiotic Pre-Medication (Most Patients) (Few Patients) (Most Patients) (Few Patients)
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• Congenital heart disease only in the
• Congenital heart disease only in the
• Congenital heart conditions such as:
• Congenital heart conditions such as:
disease, including those with pal iative
disease, including those with pal iative
disease with prosthetic material or device,
catheter intervention, during the first six
intervention, during the first six months
c. Repaired congenital heart disease with
c. Repaired congenital heart disease with
residual defects at the site or adjacent to
residual defects at the site or adjacent to
the site of a prosthetic patch or prosthetic
the site of a prosthetic patch or prosthetic
device (which inhibit endothelialization)
device (which inhibit endothelialization)
• Cardiac transplantation recipients with
• Cardiac transplantation recipients with
In Conclusion In Conclusion
For most heart patients, this means you wil no longer be asked to pre-medicate prior to dental
For most heart patients, this means you wil no longer be asked to pre-medicate prior to dental
treatment. For more information on this subject, you can go to the American Heart Association at
treatment. For more information on this subject, you can go to the American Heart Association at
www.americanheart.org/presenter.jhtml?identifier=11086 www.americanheart.org/presenter.jhtml?identifier=11086
If a patient has been prescribed dental pre-medication by a medical doctor, he/she may wan t to
If a patient has been prescribed dental pre-medication by a medical doctor, he/she may want to
consult his/her physician regarding the new guidelines and ask if pre-medication is stil needed.
consult his/her physician regarding the new guidelines and ask if pre-medication is stil needed.
Compliments of Compliments of Roger D. Craddock, D.D.S. and Mitchel S. Godat, D.D.S., M.S. Roger D. Craddock, D.D.S. and Mitchel S. Godat, D.D.S., M.S.
Office: (901) 761-3770 Fax: (901) 761-3775
Office: (901) 761-3770 Fax: (901) 761-3775
Antibiotic Pre-Medication Regimens for Dental Procedures Antibiotic Pre-Medication Regimens for Dental Procedures (For Prevention of Infective Endocarditis) (For Prevention of Infective Endocarditis) Guidelines from the American Heart Association – Published April 2007 Guidelines from the American Heart Association – Published April 2007 Regimen – Single Dose Regimen – Single Dose Situation 30-60 minutes before procedure Situation 30-60 minutes before procedure Adults Children Adults Children
*IM – intramuscular; IV – intravenous.
*IM – intramuscular; IV – intravenous.
**Or other first or second generation oral cephalosporin in equivalent adult or pediatric dosage.
**Or other first or second generation oral cephalosporin in equivalent adult or pediatric dosage.
Cephalosporins should not be used in an individual with a history of anaphylaxis, angioedema,
Cephalosporins should not be used in an individual with a history of anaphylaxis, angioedema,
or urticaria with penicil ins or ampicil in
or urticaria with penicil ins or ampicil in
Joint Replacement Regimen*: Table 4: Dental Procedures for Which Joint Replacement Regimen*: Table 4: Dental Procedures for Which
Antibiotic prophylaxis is NOT indicated for
Endocarditis Prophylaxis is Recommended
Antibiotic prophylaxis is NOT indicated for
Endocarditis Prophylaxis is Recommended
dental patients with pins, plates and screws,
If Pre-Medication is Indicated
dental patients with pins, plates and screws,
If Pre-Medication is Indicated
nor is it routinely indicated for most dental
nor is it routinely indicated for most dental
Antibiotic pre-medication IS advisable prior
All dental procedures that involve
Antibiotic pre-medication IS advisable prior
All dental procedures that involve
to al high-risk dental procedures if the patient
to al high-risk dental procedures if the patient
• A joint replacement less than two years ago.
• A joint replacement less than two years ago.
• Previous infections in an artificial joint.
• Previous infections in an artificial joint.
DO NOT need antibiotic prophylaxis: do not need antibiotic prophylaxis:
• An inflammatory type of arthritis, type 1
• Routine anesthetic injections through
• Routine anesthetic injections through
• An inflammatory type of arthritis, type 1
• Placement of removable prosthodontic or
• Placement of removable prosthodontic or
• Adjustment of orthodontic appliances
• Adjustment of orthodontic appliances
• Bleeding from trauma to the lips or oral
• Bleeding from trauma to the lips or oral
International Journal of Obesity (2001) 25, 1095±1099ß 2001 Nature Publishing Group All rights reserved 0307±0565/01 $15.00www.nature.com/ijoPAPERGastrointestinal side effects of orlistat may beprevented by concomitant prescription of natural®bers (psyllium mucilloid)H Cavaliere1, I Floriano1 and G Medeiros-Neto1*1Department of Clinical Medicine, University of SaÄo Paulo Medical School,
The Importance of Potassium By Hans R. Larsen MSc ChE Important: Please read this entire report before acting on its findings Potassium is fairly abundant in the body with a total content of about 135 grams (3500 mmol). Most, 98% to be exact, is found inside the cells, while the remaining 2% or about 2700 mg is found outside the cells, more specifically in blood serum. Blood serum