| 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). |
