New guidelines suggest that most patients with heart disease do not need antibiotic prophylaxis for infective endocarditis before undergoing dental procedures
Most patients with heart disease do not need antibiotic
prophylaxis for infective endocarditis before undergoing dental procedures, according
to new guidelines from the American Heart Association published online April 19
by Circulation.
The revised guidelines on prevention of infective endocarditis
were based on a review of new and existing scientific evidence. In the revision,
antibiotics prior to dental work are now only recommended for patients at greatest
risk of negative outcomes from infective endocarditis: This includes patients
with artificial valves or certain congenital heart conditions, heart transplant
recipients who develop cardiac valve problems, recipients of an artificial patch
to repair a congenital heart defect within the past six months, and patients with
a history of infective endocarditis.
The new guidelines are based on a growing body of scientific
evidence that shows the risks of taking preventive antibiotics outweigh the benefits
for most patients. The risks include adverse reactions that range from mild to
potentially severe and, in rare cases, are life-threatening or lethal. Inappropriate
use of antibiotics can also lead to development of drug-resistant bacteria.
The guidelines state that patients who took prophylactic
antibiotics routinely in the past but no longer need them include people with
mitral valve prolapse, rheumatic heart disease, bicuspid valve disease, calcified
aortic stenosis, or congenital heart conditions such as ventricular septal defect,
atrial septal defect, and hypertrophic cardiomyopathy.
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