Antibiotic Regimens (SDCEP)
Important (UK context): The regimens below are based on the SDCEP Antibiotic Prophylaxis Against Infective Endocarditis Implementation Advice published in August 2018. SDCEP has signalled that certain aspects of this advice (e.g., classification of high-risk groups and recommended drug regimens) are being reviewed in light of evolving evidence.
While that review is ongoing, the current SDCEP advice remains applicable in UK dental practice and should be followed alongside NICE Clinical Guideline 64 and local antimicrobial/cardiology guidance.
If antibiotic prophylaxis is required, an appropriate oral regimen is:
| Amoxicillin, 3 g Oral Powder Sachet | Dose for children |
|---|---|
| Give: 3 g (1 sachet) 60 minutes before procedure | Amoxicillin Oral Suspension*, 250 mg/5 ml or 3 g Oral Powder Sachet* |
| (3 g prophylactic dose) | 6 months – 17 years: 50 mg/kg; maximum dose 3 g (prophylactic dose) |
NB:
- Amoxicillin, like other penicillins, can cause hypersensitivity reactions, including rashes and anaphylaxis. Avoid in patients with a history of anaphylaxis, urticaria, or rash following penicillin administration.
- Antibiotics can, rarely, be associated with Clostridioides difficile infection/antibiotic-associated colitis (risk varies by drug and patient factors).
- Amoxicillin can alter the anticoagulant effect of warfarin; INR should be monitored in warfarin users.
- Sugar-free preparation is available.
In patients who are allergic to penicillin, an appropriate oral regimen is:
Safety / guideline note: SDCEP (2018) includes clindamycin for “true” penicillin/beta-lactam allergy, and some UK local guidance still lists it. However, some international guidance has moved away from clindamycin for dental IE prophylaxis because of a higher risk of severe adverse reactions. If clindamycin is unsuitable, follow local policy and seek expert advice for alternatives.
| Clindamycin Capsules, 300 mg | Dose for children |
|---|---|
| Give: 600 mg (2 capsules) 60 minutes before procedure | 6 months – 17 years: 20 mg/kg; maximum dose 600 mg (prophylactic dose) |
NB:
- Advise patients to swallow capsules with a glass of water.
- Do not prescribe clindamycin to patients with diarrhoeal conditions.
- Be aware of the risk of antibiotic-associated colitis, which can be severe and rarely fatal.
- Clindamycin is unavailable as an oral suspension. Azithromycin oral suspension may be a suitable alternative for children unable to take capsules (check local guidance).
In patients who are allergic to penicillin and unable to swallow capsules, an appropriate oral regimen is:
| Azithromycin Oral Suspension 200 mg/5 ml | Dose for children |
|---|---|
| Give: 500 mg (12.5 ml) 60 minutes before procedure | 6 months – 11 years: 12 mg/kg; maximum dose 500 mg |
| (500 mg prophylactic dose) | 12–17 years: 500 mg (prophylactic dose) |
NB:
- Azithromycin can cause abdominal discomfort, diarrhoea, nausea, and vomiting.
If clindamycin is not suitable: depending on local cardiology/antimicrobial guidance, alternatives used in some guidance include a macrolide (e.g. azithromycin/clarithromycin) or doxycycline. Some guidance may allow a cephalosporin in patients without immediate-type penicillin reactions (avoid cephalosporins if history of anaphylaxis/angioedema/urticaria to penicillin/ampicillin). Always confirm the patient’s allergy history and follow local policy.
For patients who require intravenous prophylaxis, an appropriate regimen is:
| Amoxicillin | Dose for children |
|---|---|
| Give: 1 g i.v. just before the procedure or at induction of anaesthesia | 6 months – 17 years: 50 mg/kg; maximum dose 1 g |
NB:
- Amoxicillin, like other penicillins, can cause hypersensitivity reactions. Avoid in patients with penicillin hypersensitivity.
- Amoxicillin can alter the anticoagulant effect of warfarin; monitor INR in warfarin users.
For patients who require intravenous prophylaxis and are allergic to penicillin, an appropriate regimen is:
| Clindamycin | Dose for children |
|---|---|
| Give: 300 mg i.v. just before the procedure or at induction of anaesthesia | 6 months – 17 years: 20 mg/kg; maximum dose 300 mg |
NB:
- Avoid prescribing clindamycin to patients with diarrhoeal conditions.
- Monitor for antibiotic-associated colitis, which can be severe and rarely fatal.