Latest Prophylaxis Guidelines....

  Hello,
    I was operated on by Dr.Cosgrove in 1994 for my aortic valve which had a congenital defect and was further damaged by endocarditis. All went well,
  and I am doing GREAT! I thank GOD for Dr. Cosgroves expertise everyday, Everyone at Cleveland Clinic is to be commended for their professional, helpful ways. My wife and I would have been basket cases without you all.
  I am now 42 years old and have no limitations in activities and no medications at all. My question involves the use of prophylaxis, I guess what thats what the antibiotic regimen is called, prior to dental or other invasive procedures. I have been using the regimen given me at CCF in 1994, which was then the High Risk regimen of Ampicillin/Gentamicin. I understood then that High risk patients took this regimen for all procedures, that is Dental/Oral/Upper Resp.Tract AND Genitourinary/Gastrointestinal procedures.I've ee recent charts that show this regimen NOW used only for the Genitourinary/Gastro procedures and the standard Amoxicillin used in dental,etc. EVEN in High Risk patients?! What is the correct regimen now? I want to play it safe, but not over use antibiotics. Thanks again and God Bless. A.Kohnfelder

[CCF Cardio MD - MTR]

Dear Albert, thank you for your question.  The AHA guidelines for endocarditis prophylaxis have recently been amended and include some changes that you allude to in your posting on the heart forum.    Dental procedures are considered to be "lower risk" than genitourinary or gastrointestinal procedures so the standard regimen now is to give 2.0 grams of Amoxicillin 1 hour before the dental procedure.  If you are unable to take oral medications or if you are allergic to penicillin, then other antibiotic regimens can be used.   However, you will no longer need intravenous antibiotics for dental procedures.  This antibiotic regimen is now recommended for all patients with a risk of endocarditis who undergo dental procedures regardless of their risk status.  For genitourinary or gastrointestinal procedures, the risk status of the patient is still considered in the determination of antibiotic regimens.  Thus, I hope this answers your question, but remember to check with your own cardiologist before the dental procedure.  Also, thank you for your kind words about Cleveland Clinic and Dr. Cosgrove.  I will pass on your thoughts to his office.

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