On 10 April 2026 ADA Ltd published the latest guidelines for Infective Endocarditis (IE) prophylaxis for dental procedures. Here is a summary.
Antibiotic Prophylaxis is only recommended for patients having both a high risk procedure and a cardiac condition that increases the risk of developing IE.
High risk procedures are
- Dental extractions
- Implant placement
- Biopsy or removal of soft tissue or bone
- Scaling (supragingival and subgingival)
- Replanting avulsed teeth
Please note – Routine local analgesic injections through non-infected tissue, radiographs, placement of removable prostheses, or adjustment of orthodontic appliances are not indications for prophylaxis.
High Risk Cardiac Conditions
- Prosthetic cardiac valve (including transcatheter-implanted prostheses or homografts)
- Prosthetic material used for valve repair (e.g., annuloplasty rings)
- Previous infective endocarditis
- Ventricular assist devices
- Specific congenital heart diseases: unrepaired cyanotic defects, or repaired defects with residual defects near prosthetic material
- Rheumatic heart disease
Patients with isolated pericarditis, pacemakers, or those with prosthetic joints do not warrant prophylaxis solely for dental procedures.
Antibiotic selection
Antibiotic prophylaxis is not a substitute for good oral hygiene or timely management of oral disease. The overuse of antibiotics is discouraged due to resistance and adverse effects; prophylaxis is now recommended far less often than in the past.
Here are the preferred regimes in order of preference:
Orally
- Amoxicillin: 2 g (child: 50 mg/kg up to 2 g) orally, 60 minutes before procedure
or - Cefalexin: 2 g (child: 50 mg/kg up to 2 g) orally, 60 minutes before procedure for non-severe penicillin allergy
or - Doxycycline: adult 100 mg, child 2.2 mg/kg (if <21 kg) orally, 60 minutes before procedure, for severe penicillin allergy
or - Azithromycin: 500 mg (child: 10 mg/kg up to 500 mg) orally, 60 minutes before procedure, for severe penicillin allergy
Parenterally (if oral administration is not possible)
- Amoxicillin or Ampicillin: 2 g (child: 50 mg/kg up to 2 g) IM or IV, 30–60 minutes before procedure
or - Cefazolin: 2 g (child: 30 mg/kg up to 2 g) IM or IV, 30–60 minutes before procedure for non-severe penicillin allergy
or - Azithromycin: 500 mg (child: 10 mg/kg up to 500 mg) IV, 60 minutes before procedure for severe penicillin allergy or if cefazolin cannot be used
This is just a brief summary and the full article can be read via this link: Medicines information: Endocarditis prophylaxis for dental procedures | Australian Dental Association
