Procedures That May Require Antibiotics to Prevent Endocarditis

Topic Overview

The American Heart Association recommends preventive (prophylactic) antibiotics for some people who are at increased risk for developing endocarditis.1 These people should have preventive antibiotics before they have certain procedures that may release bacteria into the bloodstream.

If you are at increased risk for endocarditis, talk with your doctor or your dentist about the need for preventive antibiotics before having any of these procedures or surgeries. Although antibiotics can reduce the risk for developing endocarditis, taking them does not provide 100% protection.

If your doctor or dentist determines that you need to take preventive antibiotics, they generally are given 30 minutes to 1 hour before the procedure.

When antibiotics are recommended
Dental procedures
  • Tooth removal (extractions), implants, or reimplantation of teeth lost from injury
  • Periodontal procedures, such as oral surgery, scaling, root planing, and probing
  • Gum surgery
  • Removal of stitches
  • Initial placement of orthodontic bands (not brackets)
  • Teeth cleaning
Respiratory tract (airway) procedures
  • Tonsil or adenoid removal
  • Respiratory tract surgery or biopsy
Skin, bone, or tissue procedures
  • Surgery that involves infected skin, bone, or muscle tissue, such as surgery to remove infected bone (osteomyelitis) or infected tissue


When antibiotics are NOT needed
Dental procedures
  • Tooth restoration or replacement, unless significant bleeding is expected
  • During the buildup of the new tooth material phase of a root canal (intracanal endodontic treatment, post placement, and buildup)
  • Placement of rubber dams
  • Placement, adjustment, or removal of mouth (orthodontic) appliances (such as braces or retainers)
  • Oral impressions
  • Mouth X-rays
  • Loss of baby tooth (primary tooth)
  • Shots used to numb the mouth
Respiratory tract (airway) procedures
  • Insertion of a tube through the nose or mouth to open or widen the airway, give anesthesia, or remove secretions (endotracheal intubation)
  • A procedure in which a flexible tube is guided down your throat to look into your breathing tubes (flexible bronchoscopy, with or without biopsy)
  • Eardrum incision for tube placement (tympanostomy)
Stomach and intestinal tract procedures
  • All stomach and intestinal tract procedures and surgeries
Urinary system procedures
  • All urinary system procedures and surgeries
Other procedures
  • Cardiac catheterization, including balloon angioplasty
  • Implanted cardiac pacemakers
  • Implanted defibrillators and coronary stents
  • Incision or biopsy of surgically scrubbed skin
  • Circumcision
  • Ear and body piercing
  • Tattooing
  • Hysterectomy



  1. Wilson W, et al. (2007). Prevention of endocarditis. Guidelines from the American Heart Association. A guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. Published online April 19, 2007 (doi:10.1161/circulationaha.106.183095).


Author Robin Parks, MS
Editor Kathleen M. Ariss, MS
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer John A. McPherson, MD, FACC - Cardiology
Last Updated April 16, 2009

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