Antibiotics for Endocarditis Prevention

[Karina]

A couple of days ago I cut myself with rusty and very used garden scissors, a small but deep slash which required 3 stitches. I am 55 and have always taken antibiotics before dental cleanings and invasive medical procedures for MVP with minor regurgitation. The cut was cleaned, covered and I was given a tetanus shot. 12 hours later, I took 2 gr. of amoxicillin on my own, then 12 hours later, another 2 gr. , then 12 hours later, 1 gr. because it was a weekend and I could not contact any Dr. When I finally did talk to an emergency physician, he told me that I didn't need to take antibiotics unless the cut showed signs of infection, but I am still worried. Is this standard procedure for dirty cuts? I also worry that taking antibiotics every 6 months for dental cleanings will create antibiotic resistance. Please comment on this also.

[Cleveland Clinic]

karina,

thanks for the post.

Believe it or not, there are not really good scientific studies looking at whether endocarditis prophylaxis works at all in patients at risk for the disease. Given the serious sequelae of the disease, we err on the side of providing prophylaxis. To estimate risk -- we try to identify those at risk with such conditions as valve replacement or abnormal valvular pathology and the insults that can lead to bacteremia. Overall, a superficial cut has a low risk for bacteremia and MVP is on the lower spectrum of valvular risk so prophylaxis could be argued either way.

Over use of antibiotics can lead to resistance. That is why we try to limit their use and when used, administer a full course. It is important to take your medication exactly as directed to limit the risk.

good luck

[Karina]

My ECG repeatedly shows bradycardia every time. Does this raise any concern for patients with MVP with minor regurge?

[Celeste07]

I also have MVP with mild regurge, although in 2 out of 8 of my  echo's, the MVP was questionable (doc said this happens).  However, my dentist ALWAYS prescribes antibiotics before any dental procedure. According to my cardiologist and my dentist, the risks associated with endocarditis far outweigh the risk of developing antibiotic resistance. My dentist has also switched my antibiotics back and forth between Clindamycin and Omnicef if I have multiple procedures during the course of the year.
My Cardiologist stated that the risk of any associated antibiotic resistance developing due to the small doses of antibiotics given for annual dental procedures would be very very very minimal if any.
For several years, my daughter has had multiple life threatening health issues, (triple pneumonia, sepsis due to kidney stones a few times, uterine infection after giving birth, etc). During those times, she had to take antibiotics for weeks on end, even months. If it adds some reassurance, she has never developed antibiotic resistance to this date. I think the key to avoiding resistance is just as CCF-M.D.-bkj stated.

I hope you feel better soon, your not alone in your worries!
Celeste