你問的問題很好，也很重要。
根據最新版內科聖經Harrison的內容
Table 109–7. Procedures for which Endocarditis Prophylaxis Is Advised in
Patients at High or Moderate Risk for Endocarditisa
(在moderate/high risk patient做以下dental procedure時建議用antibiotics)
Dental procedures
Extractions
Periodontal procedures, cleaning causing gingival bleeding
Implant placement, reimplantation of avulsed teeth
Endodontic instrumentation (root canal) or surgery beyond the apex
Subgingival placement of antibiotic fibers or strips
Placement of orthodontic bands but not brackets
Intraligamentary injections (anesthetic)
Table 109–8. Cardiac Lesions for which Endocarditis Prophylaxis Is Advised
(moderate/high risk patient的區分，不用死背，我的觀念是：先前有endocartitis
history,heart「型態」上不正常的(先天畸型、瓣膜有問題)要小心。請注意，這裡並沒有提到冠
狀動脈硬化疾病哦)
High Risk
Prosthetic heart valves
Prior bacterial endocarditis
Complex cyanotic congenital heart disease; other complex congenital lesions
after correction (see text)
Patent ductus arteriosus
Coarctation of the aorta
Surgically constructed systemic-pulmonary shunts
Moderate Risk
Congenital cardiac malformations (other than high-/low-risk lesions),
ventricular septal defect, bicuspid aortic valve
Acquired aortic and mitral valve dysfunction
Hypertrophic cardiomyopathy (asymmetric septal hypertrophy)
Mitral valve prolapse with valvular regurgitation and/or thickened leaflets
Table 109–9. Cardiac Conditions That Are Considered to Pose a Low Risk of
Endocarditis and for which Antibiotic Prophylaxis Is Not Recommended
(剛才提到「型態上」不正常的要注意，但是也有以下的例外)
Isolated secundum ASD
Surgically repaired ASD, VSD, PDA (without residual defect, >6 months after
repair)
Prior coronary artery bypass graft
Mitral valve prolapse without regurgitation or thickened leaflets
Physiologic or functional murmur
Prior Kawasaki disease or acute rheumatic fever without valve dysfunction
Cardiac pacemakers or implanted defibrillators
Table 109–10. Antibiotic Regimens for Prophylaxis of Endocarditis in Adults
at Moderate or High Risk
(以下是用藥)
I. Oral cavity, respiratory tract, or esophageal proceduresb
A. Standard regimen
1. Amoxicillin 2.0 g PO 1 h before procedure
B. Inability to take oral medication
1. Ampicillin 2.0 g IV or IM within 30 min of procedure
C. Penicillin allergy
1. Clarithromycin 500 mg PO 1 h before procedure
2. Cephalexinc or cefadroxilc 2.0 g PO 1 h before procedure
3. Clindamycin 600 mg PO 1 h before procedure or IV 30 min before
procedure
D. Penicillin allergy, inability to take oral medication
1. Cefazolinc 1.0 g IV or IM 30 min before procedure
有錯的地方請指教
如果不清楚的話再寫信or打電話給我吧
dodolo7@ms22.hinet.net
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