Antibiotic Guidelines Endocarditis Prophylaxis

  • Infective endocarditis in children with heart "defects"

    Patients "at risk"

    Low risk

    • All children with Structural Congenital Heart Defects (except isolated ASD secundum?)*
    • All children with OPERATED heart defects (except repaired ASD secundum and PDA)*
    • Children with acquired Valve Disease*
    • Children with Endocardial Pacemakers*  

    High risk

    • Unrepaired cyanotic heart defects
    • Previous Endocarditis
    • Prosthetic valves, Conduits, 'Shunts'

    Patients not at risk

    • Children with murmurs if confirmed "Innocent"
    • Children with non-structural problems (eg. Arrhythmia)
    • Children with history of Kawasaki's disease

    Subject to advice from patient's cardiologist

    Endocarditis prophylaxis

    Dental Procedures and procedures on mouth, skin or musculoskeletal structures where a bacteraemia may occur.

    Low risk


    Antibiotic cover is no longer recommended as a routine in low risk patients (eg Prosthetic Valve/Previous endocarditis/Cyanotic heart defect)

    High risk

    • Amp/Amoxycillin 50 mg/kg IV pre-op (at induction - max 2 gm) Single dose only
    • (If Penicillin sensitive - Vancomycin - 20 mg/kg IV infused over 1 hr pre-op (max 1 gm)


    Antibiotic cover for genito-urinary or gastro-intestinal procedures is not recommended for prophylaxis of endocarditis.


    Adapted from "Antibiotic Guidelines 1992/93"- Victorian Medical Postgraduate Foundation and amended in line with AHA recommendations 2007. (RCH Cardiology - 2009)

    These guidelines are recommended by The Royal Children's Hospital Cardiology Department. They may be different from the Guidelines / Recommendations at other centres