ASK DR. H: Guidelines changed for antibiotic usage

Q: For years, I’ve been getting a prescription of amoxicillin to take before seeing the dentist because of a history of a leaky mitral valve. However, my new doctor recently refused to give me a prescription, saying that it’s no longer necessary. I am concerned about the safety of this and am writing you for advice. Is he right? — S.K., Altamonte Springs, Fla.

A: Although it might make you uneasy to skip the antibiotic you’ve taken in the past to prevent an infection of your leaky heart valve, the latest guidelines from the American Heart Association and the American Dental Association support your new doctor.

The guidelines are based upon the lack of evidence that taking antibiotics before dental procedures for most heart valve conditions reduces the risk of developing infective endocarditis. Such heart conditions include mitral valve prolapse with orwithout heart murmur, rheumatic heart disease, calcified aortic valve stenosis, congenital heart conditions such as ventricular and atrial septal defects (holes between the right and left chambers) and hypertrophic cardiomyopathy (an abnormally thickened heart).

These folks have hearts that already are exposed to bacteria from the mouth, which can enter their bloodstream during basic daily activities such as brushing or flossing. The new guidelines are based on a number of studies that indicate that endocarditis is more likely to occur as a result of these everyday activities than from a dental procedure.

Taking antibiotics unnecessarily can lead to antibiotic-resistant bacteria as well as side effects or allergic reactions. There are some heart conditions where antibiotics before dental work is still advised. This includes people with artificial heart valves, with a prior history of infective endocarditis and with certain serious heart valve conditions.

Dr. Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: “Ask Dr. H,” P.O. Box 767787, Roswell, GA 30076. Because of the large volume of mail received, personal replies are not possible.

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