Patient condition

Procedure contemplated

Antibiotic prophylaxis

High risk:

Prosthetic valve

History of endocarditis

Systemic -pulmonary shunt

Complex cyanotic congenital heart disease

Stricture dilation

Variceal sclerotherapy

ERCP/obstructed biliary tree

Not recommended

Other endoscopic procedures, including EGD and colonoscopy (with or without biopsy/polypectomy), variceal ligation

Not recommended

Moderate risk:

Most other congenital abnormalities

Acquired valvular dysfunction (eg, rheumatic heart disease)

Hypertrophic cardiomyopathy

Mitral valve prolapse with regurgitation or thickened leaflets

Esophageal stricture dilation

Variceal sclerotherapy

Not recommended

Other endoscopic procedures, including EGD and colonoscopy (with or without biopsy/polypectomy), variceal ligation

Not recommended

Low risk:

Other cardiac conditions (CABG, repaired septal defect or patent ductus, mitral valve prolapse without valvular regurgitation, isolated secundum atrial septal defect, physiologic/functional/innocent heart murmurs, rheumatic fever without valvular dysfunction, pacemakers, implantable defibrillators)

All endoscopic procedures

Not recommended

Obstructed bile duct without cholangitis

ERCP with complete drainage

Not recommended

Obstructed bile duct with cholangitis

ERCP with anticipated incomplete drainage

Recommended (continue antibiotics after procedure)

Pancreatic cystic lesion

ERCP, EUS-FNA

Recommended

Cirrhosis acute GI bleed (required for patients with or without endoscopic procedures)

All endoscopic procedures

Recommended

Ascites, immunocompromised patient

Stricture dilation

Variceal sclerotherapy

Other endoscopic procedures, including EGD and colonoscopy (with or without biopsy/polypectomy), variceal ligation

No recommendation

All patients

Percutaneous endoscopic feeding tube placement

Recommended (parenteral cephalosporin or equivalent)

Vascular graft

AHA: Recommended antibiotic usage within 6 months of procedure

ASGE: Antibiotics not recommended

Prosthetic joints

All endoscopic procedures

Not recommended

Cardiac prophylaxis regimens (oral 1 hr before, IM or IV 30 min before procedure)

Amoxicillin by mouth or ampicillin IV: adult 2.0 g, child 50 mg/kg

Penicillin allergic: clindamycin (adult 600 mg, child 20 mg/kg), or cephalexin or cefadroxil (adults 2.0 g, child 50 mg/kg), or azithromycin or clarithromycin (adult 500 mg, child 15 mg/kg), or cefazolin (adult 1.0 g, child 25 mg/kg IV or IM), or vancomycin (adult 1.0 g, child 10-20 mg/kg IV).