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Endocarditis prophylaxis — ABIM Board MCQ

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EasyCardiovascularEndocarditis prophylaxisABIM Board

A 68-year-old man with a prosthetic mitral valve is scheduled for a dental extraction involving manipulation of gingival tissue. He has no medication allergies and no evidence of active infection. Which of the following is the most appropriate recommendation to prevent infective endocarditis?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Amoxicillin 2 g orally 30–60 minutes before the procedure

Patients with a prosthetic cardiac valve are at high risk for adverse outcomes from infective endocarditis. Antibiotic prophylaxis is reasonable when they undergo a dental procedure involving manipulation of gingival tissue, the periapical region of a tooth, or perforation of oral mucosa. In an adult who can take oral medication and has no penicillin allergy, the recommended regimen is amoxicillin 2 g orally as a single dose 30–60 minutes before the procedure. Therefore, C is correct. Cephalexin and doxycycline are alternative oral regimens for patients allergic to penicillin or ampicillin, so they are not preferred here. No prophylaxis would be inappropriate given the combination of a prosthetic valve and invasive dental work. Vancomycin plus gentamicin is not a recommended dental prophylaxis regimen.

Reference: American Heart Association. Prevention of Infective Endocarditis wallet card, updated August 2024. https://www.heart.org/-/media/files/health-topics/infective-endocarditis/infective-endocarditis-wallet-card.pdf