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Procedures That May Require Antibiotics to Prevent Endocarditis

Topic Overview

Some people who are at risk for Reference endocarditis Opens New Window take preventive (prophylactic) antibiotics before they have certain dental or surgical procedures that could put bacteria or fungi into their blood. The antibiotics lower the risk of getting endocarditis.

Not all people who may have risk factors for endocarditis take antibiotics. The people who take antibiotics have certain heart conditions that make getting endocarditis even more dangerous. If you do not have these conditions, antibiotics are not likely to help you.

These heart conditions include:

Reference Artificial heart valves Opens New Window.
Endocarditis in the past.
Heart defects since birth (Reference congenital heart defects Opens New Window).
Reference Heart valve Opens New Window problems after a heart transplant.

Talk to your doctor or dentist

Your doctor can tell you whether you need to take antibiotics. Before you have any medical, dental, or surgical procedures, tell all other health professionals who may treat you that you are at risk for endocarditis.

If your doctor or dentist recommends that you take preventive antibiotics, the medicine typically is given 30 minutes to 1 hour before the procedure.

What procedures need antibiotics?

Dental procedures	Tooth removal (extractions), implants, or reimplantation of teeth lost from injury Periodontal procedures, such as oral surgery, scaling, root planing, and probing Gum surgery Removal of stitches Initial placement of orthodontic bands (not brackets) Teeth cleaning
Respiratory tract (airway) procedures	Tonsil or adenoid removal Respiratory tract surgery or Reference biopsy Opens New Window
Skin, bone, or tissue procedures	Surgery that involves infected skin, bone, or muscle tissue, such as surgery to remove infected bone (Reference osteomyelitis Opens New Window) or infected tissue

What procedures do not need antibiotics?

Dental procedures	Tooth restoration or replacement, unless significant bleeding is expected During the buildup of the new tooth material phase of a root canal (intracanal endodontic treatment, post placement, and buildup) Placement of rubber dams Placement, adjustment, or removal of mouth (orthodontic) appliances (such as braces or retainers) Oral impressions Mouth X-rays Loss of baby tooth (primary tooth) Shots used to numb the mouth
Respiratory tract (airway) procedures	Insertion of a tube through the nose or mouth to open or widen the airway, give anesthesia, or remove secretions (endotracheal intubation) A procedure in which a flexible tube is guided down your throat to look into your breathing tubes (flexible bronchoscopy, with or without biopsy) Eardrum incision for tube placement (tympanostomy)
Stomach and intestinal tract procedures	All stomach and intestinal tract procedures and surgeries
Urinary system procedures	All urinary system procedures and surgeries
Other procedures	Cardiac catheterization, including balloon angioplasty Implanted cardiac pacemakers Implanted defibrillators and coronary stents Incision or biopsy of surgically scrubbed skin Circumcision Ear and body piercing Tattooing Hysterectomy

By:	Reference Healthwise Staff	Last Revised: Reference March 9, 2011
Medical Review:	Reference E. Gregory Thompson, MD - Internal Medicine Reference W. David Colby IV, MSc, MD, FRCPC - Infectious Disease