antibiotic prophylaxis

[LImom]

I was just wondering if you could comment on the new recomendations for antibotics before dental work. My daughter & myself have bicuspid aortic valve with moderate aortic insufficiency and in the past have been told that it is extremely important to receive antibiotics before any dental work. Now my cardiologist is telling me it is no longer needed, my daughter isn't due to see the ped card till Nov so I don't know if he has changed his mind on this also. What are your thoughts on the subject?

[Cleveland Clinic]

There is no good evidence that antibiotics work for prophylaxis at all.  Also, giving patients unnecessary antibiotics may lead to increased bacterial resistance.  These two facts combined led AHA/ACC, with guidance from the infectious disease specialists, to change the guidelines.  Of course, we are monitoring eveything that is happening and all trends are recorded.  If there is evidence that this approach leads to more cases of endocarditis then I am sure the guidelines will change.  

[Izy]

[kitcurious]

The AHA changed their guidelines back in the spring. Now they only recommend it for the most serious of heart patients, like if you had an artificial valve, previous SBE or something equally serious.

My dental hygienist asked me of I had premedicated a few weeks ago at my 6- month appointment and I said no, cardiologist said not necessary anymore.  The dentist  then came in and agreed that it was no longer necessary. Apparently there isn't even any real evidence to prove the prophylactic antibiotics work, but if they do they are being reserved for people with very sick hearts that would suffer very bad outcomes if they  acquired an infection.

[francie12]

I've heard of this new development and will be very interested to hear a Cleveland Clinic dr's opinion on it.  My son also has a bicuspid valve--mod/severe insufficiency.  I suspect the antibiotic prophylaxis might have been a factor in his year-long bout with GERD and would be happy to stop giving it before dental appointments.  On the other hand, I'm nervous, and think if there is a possible benefit...  Anyway, good luck to you and your daugther.  

[LImom]

I don't know if I am sold on this idea. Listen to what the doctor says( "Of course, we are monitoring eveything that is happening and all trends are recorded.  If there is evidence that this approach leads to more cases of endocarditis then I am sure the guidelines will change.") This doesn't sound to me like they are sure that this wont cause people like us to get endocarditis from some of these procedures. My daughter's cardiologist was just so stern about the severity of her having anything done without any antibiotics I can't believe he was just completely wrong.He is one of the top docs at Scnieder Childrens Hospital. I can't wait till Nov for her appt to talk to him. Any way thank for the reponses.