What is the recommended prophylaxis for dental procedures in patients with prosthetic heart valves?

• A. Amoxicillin 2 g orally before the procedure
• B. Clindamycin 600 mg orally before the procedure
• C. Azithromycin 500 mg orally before the procedure
• D. Doxycycline 100 mg orally before the procedure

Answer: (A)

Preventing infective endocarditis during dental work relies on antibiotic protection for those at highest risk, such as people with prosthetic heart valves. The best choice is amoxicillin 2 g taken by mouth about 30 to 60 minutes before the procedure. This dose provides reliable serum levels quickly to blunt the transient bacteremia that can seed a prosthetic valve. Amoxicillin is favored for its good absorption, effectiveness against common oral bacteria, and convenient single pre-procedure dose. If a patient cannot take penicillin or has a true penicillin allergy, alternatives include clindamycin 600 mg, or azithromycin or clarithromycin 500 mg. Doxycycline 100 mg can be used in some allergy scenarios. The other options are suitable alternatives only when penicillin cannot be used, but the standard first-line prophylaxis for a patient with a prosthetic heart valve is amoxicillin.