This Appropriate Use Criteria goes as far as stating whether or not prophylactic antibiotics may be appropriate for a particular patient profile.  These antibiotic dosage recommendations are provided as an additional resource and based solely on the 2007 statement released by the American Heart Association.  The only adjustment from the original statement is the removal of Clindamycin as an antibiotic option.  This change is based on more recently published evidence.

Cross reactivity of cephalosporin antibiotics in patients with penicillin allergy is 5% for first generation drugs, and 1% for third generation drugs, so these drugs should be used unless there is a history of anaphylaxis with penicillin administration. If there is a concern, patients should be referred for allergy testing prior to administering antibiotic prophylaxis.


  1. Terico AT, Gallagher JC "Beta-lactam Hypersensitivity and Cross-Reactivity" J Pharm Pract 2014 Dec;27(6):530-44
  2. Olmos, C., et al. (2014). "Prognostic implications of diabetes in patients with left-sided endocarditis: findings from a large cohort study." Medicine (Baltimore) 93(2): 114-119.
  3. Chrastil, J., et al. (2015). "Is Hemoglobin A1c or Perioperative Hyperglycemia Predictive of Periprosthetic Joint Infection or Death Following Primary Total Joint Arthroplasty?" J Arthroplasty 30(7): 1197-1202.


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