Antibiotic Prophylaxis Dropped For Most Patients

The American College of Cardiology (ACC) and the American Heart Association (AHA) have released new guidelines on antibiotic prophylaxis for patients with valvular heart disease. For decades, doctors have been urged to give patients with almost any type of valvular heart disease antibiotics prior to any dental procedures. The reasoning has been that dental procedures often “seed” the bloodstream with bacteria, and patients with abnormal heart valves would then be at risk of developing a serious infection (called endocarditis) on the abnormal valve. Prophylactic antibiotics have been thought to reduce the risk of endocarditis following dental procedures.

However, new evidence has now led the ACC and AHA to drop this recommendation in most patients. This new evidence suggests that the very few cases of endocarditis ever occur after dental procedures, and that, in fact, most cases occur after daily activities (such as teeth brushing). The real key to preventing endocarditis, the experts now say, is maintaining excellent oral hygiene, which will reduce the risk of endocarditis with daily activities. Giving antibiotics prior to dental procedures will not only likely fail to prevent endocarditis, but also contributes to the overuse of antibiotics.

Antibiotic prophylaxis is still recommended for those whose underlying heart disease places them at particularly high risk of developing endocarditis. These patients include those with artificial heart valves, with past histories of endocarditis, or with congenital heart disease.

_Sources:

Nishimura RA, Carabello BA, Faxon DP, et al. ACC/AHA 2008 guideline update on valvular heart disease: Focused updated on infective endocarditis. J Am Coll Cardiol; DOI: 10.1016/j.jacc.2008.05.008.