Reference — Cardiac
Endocarditis Prophylaxis & Duke Criteria Reference
Two things nurses are asked about endocarditis: who needs an antibiotic before the dentist, and how it’s diagnosed. Prophylaxis is now reserved for the highest-risk hearts only.
Educational use only. Prophylaxis indications and regimens follow current AHA/ACC guidelines and provider orders; recommendations have narrowed over time. Verify against your facility’s protocol. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Who Needs Prophylaxis (highest-risk hearts)
- ✓Prosthetic heart valve or prosthetic material used in valve repair
- ✓Previous infective endocarditis
- ✓Certain congenital heart disease (unrepaired cyanotic CHD; repaired with residual defects; first 6 months after repair with prosthetic material)
- ✓Cardiac transplant recipients who develop valvulopathy
Note: prophylaxis is no longer recommended for common conditions like mitral valve prolapse, bicuspid aortic valve, or most acquired valve disease — the guidelines narrowed to these highest-risk groups.
For Which Procedures
- •Dental procedures involving the gingiva, periapical region, or oral mucosa perforation
- •Procedures on infected skin/soft tissue
- •Certain respiratory tract procedures with incision/biopsy of mucosa
Typical regimen: a single dose of amoxicillin ~30–60 minutes before the procedure (cephalexin, azithromycin/clarithromycin, or doxycycline if penicillin-allergic). Routine GI/GU procedures generally do not require prophylaxis.
Duke Criteria (Diagnosis)
| Criteria | Examples |
|---|---|
| Major | Positive blood cultures for typical IE organisms; echocardiographic evidence of endocardial involvement (vegetation, abscess, new valve regurgitation) |
| Minor | Predisposing heart condition or IV drug use; fever ≥ 38°C; vascular phenomena (emboli, Janeway lesions); immunologic phenomena (Osler nodes, Roth spots); suggestive microbiology not meeting a major criterion |
Diagnosis generally requires 2 major, or 1 major + 3 minor, or 5 minor criteria. The two pillars are positive blood cultures and echo evidence.
NCLEX Pearls
- ✦Prophylaxis is reserved for the HIGHEST-risk hearts: prosthetic valves, prior endocarditis, certain congenital heart disease, post-transplant valvulopathy.
- ✦Give it for dental procedures involving gingiva/oral mucosa — usually amoxicillin 30–60 min before (cephalexin, azithromycin/clarithromycin, or doxycycline if penicillin-allergic).
- ✦MVP and most acquired valve disease no longer warrant prophylaxis.
- ✦Duke criteria pillars = positive blood cultures + echo evidence (major); fever, emboli, Osler/Janeway/Roth, predisposition (minor).
- ✦Best prevention overall is excellent oral/dental hygiene.
Related Resources
Standards & sources
Fact-checked Jun 20, 2026This page is written to align with American Heart Association (AHA) · American College of Cardiology (ACC) · AHA ACLS Guidelines. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →