Antibiotic+Prophylaxis

These recommendations greatly reduce the indications for coverage to a limited number of cardiac conditions that include: (1) artificial heart valve; (2) previous history of infective endocarditis; (3) incomplete or repaired congenital heart tissue repair; and (4) some heart transplants. **In these patients, the regimen is 2 grams of amoxicillin 30 to 60 minutes preoperatively for adults. Children’s dosage is 50 mgm/kg. For allergic patients, a good choice is clindamycin 600 mgm 30 to 60 minutes before the procedure.**

The American Society of Orthopaedic Surgeons guidelines for prophylaxis in joint replacement patients remain unchanged from 1997. Patients considered to be at risk include those who have had joint replacements within the past 2 years, immunocompromised/immunosup-pressed or hemophiliac patients, insulin-dependent diabetics, and those with previous joint prosthesis infections. The same regimen is recommended as with cardiac patients. In these cardiac or joint prosthesis patients, endodontic procedures considered to be a risk include instrumentation beyond the apex, periapical surgery, or other procedures that may produce bleeding, such as aggressive rubber dam placement or incision for drainage.

If patient forgets to take medication:
“If the dosage of antibiotic is inadvertently not administered before the procedure, the dosage may be administered up to two hours after the procedure.” ada.org It is best to give the patient the antibiotics before you start but you do not have to wait.

link to ADA guidelines