Bacterial Endocarditis?

[RossGurlie]

Hey you guys! I know that the AHA recently put out new guidelines regarding prophylaxis before procedures in dealing with the issue of the prevention of bacterial endocarditis. I read them and am still trying to figure out if I would belong in the 'increased risk' category. I had my Ross Procedure two years ago and when I went back in May, my cardiologist told me that the conduit valve has some narrowing, and my valve (in the aortic position) has slight dilating and leaking. It's not too bad though, so I'm just going back in November to have another echo, EKG, x-ray, etc. Anyway... I am going to the dentist before school starts (ahh! I start 10th grade in a little more than a week!), and have been prescribed amoxicillin. The AHA said that the adverse effects of taking unnecessary antibiotics could be harmful if you're not actually in the increased risk category. So, I'm just wondering if you all think I would qualify as 'increased risk'. :]

P.S. This probably doesn't affect whether I'm taking the antibiotics this time. Until I talk to the dentist and/or my cardiologist, I'll just keep doing what I've been told.

 

[surfsparky]

Hello Rossgurlie,

In my view (albeit limited!) you are in the 'increased risk' category. Chris' surgeon told us that he requires life long antibiotic prophylaxis for the following procedures and conditions:

1. Dental work including scaling and cleaning
2. Any other invasive procedure including endoscopy, minor surgical procedure, dermabrasion, skin biopsy, removal of skin lesions etc
3. Infections such as bronchitis and sinusitis, cellulitis etc
4. Any other surgical inetrvention.

We have been given a letter from our surgeon to give to all doctors, dentists etc, explaining this.

I also take extra caution when Chris cuts himself and lather the area in an antispetic wash or cream! Some may say I'm taking things too far, but I'd like to err on the side of caution. I'll do anything to lessen the risk of any infection reaching his heart...he's so precious to me.

Chris like you, had the Ross Procedure.

Hope this helps,

Yolanda

 

[tobagotwo]

My understanding of it is that at this time, all of remain in that shrinking pool of extra caution. As such, the rule is still applied to us.

My belief is that this practice, which the most recent, very credible examination of over fifty years' worth of data shows to be without any discernable or measurable benefit, will be obsoleted completely and removed from the medical lexicon. The temporary continuation of this practice in limited cases will prove to be an attempt at a graceful retreat from a scientifically unsupportable position.

As you have probably read in the AHA-published study, all the evidence from fifty years of prophylactic antibiotic use concurs that they do not protect people from bacterial endocarditis.

However, you and your doctors and dentists must agree on your ground rules. Currently, they will probably be adamant that you must take the antibiotics. If you find that Amoxycillin is tough on digestion, you can opt for Clindamycin, or one of the other acceptable antibiotics. It also makes sense to take probiotics for at least a few days after the dose, if your physician allows it.

There are a number of threads about this. Here are some earlier postings, etc., in regard to this. You can find more, if you search. Be wary of the dates, so you know what information was available at the time of the posts:

http://www.valvereplacement.com/forums/showthread.php?p=248361&highlight=prophylactic#post248361

... a thread from when the new guidelines came out: http://www.valvereplacement.com/forums/showthread.php?t=20936&highlight=prophylactic

...a thread from before the study came out: http://www.valvereplacement.com/forums/showthread.php?t=20184&highlight=prophylactic

...an article about the research: http://www.medicalnewstoday.com/medi...p?newsid=69557

Best wishes,