Endocarditis Prophylaxis Antibiotic Dosing

Current American Heart Association guidelines for antibiotic dosing are:

Amoxicillin: Adults: 2 g; children: 50 mg/kg orally one hour before procedure

If allergic to penicillin, use:

  • Clindamycin: Adults: 600 mg; children: 20 mg/kg orally one hour before procedure
  • Cephalexin or cefadroxil: Adults: 2 g; children: 50 mg/kg orally one hour before procedure
  • Azithromycin or clarithromycin: Adults: 500 mg; children: 15 mg/kg orally one hour before procedure

Cephalosporins should not be used in individuals with immediate-type hypersensitivity reaction to penicillins.



  • A single dose of antibiotic covers the expected period of bacteremia.
  • Optimal timing of dose is the 2 hour window before procedure.
  • The maximum calculated dose for children should not exceed the adult dose.
  • If patients are unable to take oral agents, consult the American Heart Association for the IV or IM recommendations at¬†www.americanheart.org.
  • These guidelines change periodically. Check for updates.


Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007; 116:1736-54.

Nishamura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017; 135(25): e1159-e1195.

ADA. Antibiotic prophylaxis prior to dental procedures. Oral Health Topics 2017. www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis