Endocarditis Prophylaxis Recommended

Endocarditis prophylaxis is recommended/may be considered if individual:

1. has one or more of the high risk cardiac conditions listed below under A,


2. is undergoing one of the dental/surgical procedures listed below under B or C.

A. Cardiac Conditions Associated with Highest Risk of Adverse Outcome from Endocarditis

  • Prosthetic cardiac valves or prosthetic material:
    • presence of prosthetic cardiac valves (mechanical and bioprosthetic)
    • transcatheter implantation of prosthetic valves
    • cardiac valve repair with devices, including annuloplasty, rings, or clips
    • left ventricular assist devices or implantable heart
  • Previous, relapse, or recurrent infective endocarditis
  • Cardiac transplant recipients with cardiac valvulopathy
  • Congenital heart disease (CHD):
    • unrepaired cyanotic CHD, including palliative shunts & conduits
    • completely repaired CHD with prosthetic material or device, during the first 6 months after procedure
    • repaired CHD with residual defects at or around site of prosthetic material (which inhibit endothelialization)
    • surgical or transcatheter pulmonary artery valve or conduit placement, e.g. Melody valve and Contegra conduit     

         NB: Except for the specific conditions listed above, prophylaxis is no longer recommended for any other form of CHD.


B. Dental/oral procedures for which IE Prophylaxis is Recommended in Patients with Cardiac Conditions listed in A

  • Procedures that involve manipulation of gingival tissue or periapical region of teeth, or perforation of oral mucosa.

C. Respiratory tract procedures for which IE Prophylaxis May Be Considered in Patients with Cardiac Conditions listed in A

  • Surgical procedures that involve incision or biopsy of respiratory mucosa, e.g.
    • Tonsillectomy and/or adenoidectomy
    • Bronchoscopy with incision of respiratory tract mucosa

See Antimicrobial Regimens for Endocarditis Prophylaxis