Table 5: Endocarditis Prophylactic Regimens for Genitourinary and Gastrointestinal Procedures

Table 5:
Endocarditis Prophylactic Regimens for Genitourinary and Gastrointestinal Procedures¹
Situation	Agent	Regimen¹
High risk patients	Ampicillin plus gentamicin	Adults: ampicillin 2.0 g IM or IV, plus gentamicin, 1.5 mg/kg IM or IV (gentamicin dose should not exceed 120 mg), given within 30 min of starting procedure; 6 h later, ampicillin, 1 g IM or IV, or amoxicillin, 1 g orally³ Children: ampicillin, 50 mg/kg IM or IV (not to exceed 2.0 g), plus gentamicin, 1.5 mg/kg, within 30 min of starting procedure; 6 h later, ampicillin, 25 mg/kg IM or IV, or amoxicillin, 25 mg/kg orally³
High risk patients allergic to ampicillin/amoxicillin	Vancomycin plus gentamicin	Adults: vancomycin, 1.0 g IV over 1-2 h, plus gentamicin, 1.5 mg/kg IV or IM (gentamicin dose ampicillin/amoxicillin not to exceed 120 mg); injection or infusion should be completed within 30 min of starting procedure³ Children: vancomycin 20 mg/kg IV over 1-2 h, plus gentamicin, 1.5 mg/kg IV or IM; injection or infusion should be completed within 30 min of starting procedure³
Moderate-risk patients	Amoxicillin or ampicillin	Adults: amoxicillin 2.0 g orally 1 h before procedure, or ampicillin 2.0 g IM or IV within 30 min of starting procedure Children: amoxicillin, 50 mg/kg orally 1 h before procedure, or ampicillin, 50 mg/kg IM or IV within 30 min of starting procedure
Moderate-risk patients allergic to ampicillin/amoxicillin	Vancomycin	Adults: vancomycin 1.0 g IV over 1-2 h; infusion should be completed within 30 min of starting procedure³ Children: vancomycin 20 mg/kg IV over 1-2 h; infusion should be completed within 30 min of starting procedure³
Adapted from Dajani AS, Taubert KA, Wilson W, et al. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. JAMA. 1997; 277:1794-1801. Copyright 1997, American Medical Association. Abbreviations: IM = intramuscular; IV = intravenous Excluding esophageal procedures The total pediatric dose should not exceed the adult dose A second dose of gentamicin or vancomycin is not recommended

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