Oral antibiotic prophylaxis regimens

Oral antibiotic prophylaxis regimens

For oral antibiotic prophylaxis, the European Society of Cardiology (ESC) guideline¹⁹ recommends a 2 g oral dose of amoxicillin for adult patients without a penicillin allergy. Historically in the UK, amoxicillin 3 g oral sachets have been used for prophylaxis prior to dental procedures in adults.⁴⁵ However, it should be noted that the 3 g oral sachets are a significantly more expensive product and supply issues have previously been reported in the UK. Both amoxicillin regimens are effective for antibiotic prophylaxis and the choice of regimen should be based on patient and clinician preference, availability and cost-effectiveness.

Clarithromycin or azithromycin are suitable alternatives in penicillin allergy. If these are not suitable, the ESC guideline¹⁹ includes information on other appropriate oral prophylaxis regimens for use in penicillin allergy.

Note that the ESC guideline¹⁹ no longer recommends clindamycin due to the increased risk of adverse events (mainly related to Clostridioides difficile-associated infections) associated with this drug. Therefore, clindamycin is not recommended for antibiotic prophylaxis in this implementation advice.

Suitable oral antibiotic prophylaxis regimens are presented in the tables below. 

Oral antibiotic prophylaxis should be taken 30-60 minutes before the procedure.