Pre medicate overkill

[terry40]

I'm due for my first dental visit since surgery, the Cardiologists are having me take 2 different antibiotics IM, 30 minutes before and an oral dose 6 hours after, and of course a coumadin/Pt inr check the next day.

I'm the only one that thinks this is overkill.

I checked up on threads here and it varies what others are recommended or have taken for dental procedures.

I've been avoiding the Dentist because of this pre medication, but I have no choice now, a filling chipped off, and possibly, part of the tooth.

Anyone have similar prophylaxis requirments???

Terry40

 

[Ross]

As far as I know, it's 2000mg of Amoxicillin 1 hour before the appointment. That's all mine has ever done for me. I don't think that extra is going to be of any help myself, so yes, I think that's overkill too. What does he hope to accomplish by checking your INR the next day? Whatever it is, it's not going to show the results of the Antibiotics anyway and if it's Amoxicillin he gives you, there won't be any change anyway.

 

[hensylee]

IM? Now, that sounds like overkill, tho the antibiotic orally is SOP, I think.

 

[epstns]

My Rx for pre-med is a bit different, as I am mildly allergic to the penicillin family. I've been prescribed 600 mg of Clindamycin, 1 hour prior to dental work. No side effects from this one, either. . .

 

[Ross]

My Rx for pre-med is a bit different, as I am mildly allergic to the penicillin family. I've been prescribed 600 mg of Clindamycin, 1 hour prior to dental work. No side effects from this one, either. . .

Now yours may make a difference in INR, but not tomorrow.

 

[SJJ]

Terry,
It seems that I remember some years ago that I had to take Amoxicillin both before and after a teeth cleaning due to MVP. That's been changed, however, and like the rest of these folks posting, now I just take it one hour before (2000mg). I haven't had any dental work done since my AVR but I'm thinking the dosage will remain the same.
Sue

 

[ALCapshaw2]

The American Heart Association has a list of accepted protocols for invasive procedures, including dental. They even have it available as a pocket sized foldout (which I obtained from the cardiologist who did my last stress test).

ONE dose of 2000 mg of Amoxicillin one hour before is the first choice. Azithromycin (Zpak) is an acceptable alternative for those who are sensitive to the penicillin family. Dose is 2 tablets (500 mg?).

I suspect this info is available on www.AmericanHeart.com

'AL'

 

[Karlynn]

I take 600 mg of clindamycin 1 hour before. I'm highly allergic to the penicillan family. Several years ago they had me dosing the antibiotic before and after any dental, but now it's just an hour before.

 

[terry40]

Al, Ross, SJJ, Hensylee, Epstns,Karlynn,

Thanks for your quick responses, I knew I could find the right answer from this support group!
I looked on the AHA website, and the Cardio must have circled the wrong protocol, I had asked for a note for the Dentist, to wave the stoppage of coumadin for routine dental work (their requirment) and at the same time she also gave me the AHA sheet with this circled under High risk pts. regimens for genitournary/gastroentestional procedures. I've always taking 2.0g of amoxicillin before I had OHS, I just presumed the dose would increased post surgery and having a mechanical inplant and this dosing was the new regime even for dental work.

I'll be making some phone calls today (cardio, pcp, dentist) and get this taking care of ASAP, I need to get that tooth/filling check out.

Thanks again,

Terry40

 

[LUVMyBirman]

Hi Terry,

As stated above it's 2000 mg (4 caps) usually Amoxicillin 1 hour prior to proceedure. If you have been on Amoxicillin for another condition in the last 3 weeks or so.........then it would make complete sense to use another antibiotic to avoid resistance.

I would follow these ( "the guidelines") set by the AHA. Unless you are having a deep scaling, etc. They may want to put you on an IV drip. Print out the guidelines and show them to your doctor. We should not have to do this type of "foot work".

Good luck!

 

[Granbonny]

2,000 mg of Amox 1 hour before. Never any change in INR..I go every 3 months, for cleanings...Bonnie

 

[ericaj]

alternative

alternative

I take Zithromax 500mgs before any dental procedures.. Alternative for allergy to Amox. family.

 

[tobagotwo]

Ditto.

Two grams (usually four, 500mg capsules) of amoxycillin one hour before any dental work, unless you are allergic to penicillin.

They appear to have screwed up, unless you have other issues to which we're not privy. Go get 'em.

Best wishes,

 

[catwoman]

Terry:

My dentist told me during my first post-op dental that I should consider having at least 3, perhaps 4 dentals a year. Says he advises all patients at risk for endocarditis to have more frequent dentals, to floss more frequently (after every meal? I think he said), etc.
My dental insurance covers 2 visits a year, so I'm going to 3 a year and paying for an extra cleaning ($46), then filing it on my flex plan for reimbursement.

I run an INR test night before/morning of a dental.

It's been years since I've required any dental work done and that was a crown, probably 20 years ago.

 

[Blanche]

Terry:
Al's antibiotic protocol for dental work is the same as yours, with the exception of the shots being given one hour before dental work. He is considered high-risk because he contacted endocarditis while on oral antibiotics. Is it possible that you might have some other condition that would put you in the high-risk category?

Blanche

 

[Granbonny]

Terry

Terry

Why have you been avoiding the dentist? Because of coumadin? I have probably gone 10 times and my INR (3 days later) was normal..Apox doesn't bother it. It's when you don't go..your gums will bleed more because you are on coumadin..Mine did something awful 2 months post surgery..but the deep cleanings keep the gums healthy. I'm running about 2 months late..due to other more pressing matters everytime I had an appointment. Had to cancel to take care of Grandson the month of March when he had his appendix out..April, my 2 checkups with Cardio and PCP..I am going to call Friday..I hate appointments. something always comes up and I have to cancel or the Dr's office screwed up on time, date, ect. Wish I could just walk in dentist office and say. Hi, clean me now.. Bonnie

 

[terry40]

I put in a call to cardio, still waiting.

I think Wednesday is her day off, it's my day off too, well sorta, I work at home on the computer.

I haven't been to the dentist because of the antibiotics, my gums don't bleed when I floss or brush, I use 2 different types of rinse, 1 is the antiseptic.

My mitral valve was loaded with tumors, (myxoma) all the way down to the root, they put in a very large valve, size 29 cm, no re-growth so far. I'm not sure if that is the reasoning???

Never had endocarditis.

Here I was sure she made a mistake, now you've got me thinking 2x

Prophylactic regime she circled-Ampicillin plus gentamicin, amp-2.0g +gentamicin-1.5mg IM/IV 30 minutes before, 6 hours after ampillin 1.0g orally.

Terry

 

[The Bionic Duo]

Hmmm this is interesting, Bob just went to the Dentist a couple of weeks ago on a Friday, and he forgot to do his Coumadin test in the am like he usually does (home tester), so he tested on the Saturday after his dental appt--and got a 6.2 reading. Yikes, he thought, then remember he took antibotics the day before so decided to do nothing, and tested again the following Friday and was at 3.9. When his Cardio called for a monthly reading he told him about the two last tests and the Dr decides to make an adjustment--well his reading last Friday was 2.6, now he's a little worried that he will be too low this week--but thank god he can test this Friday and make his own adjustment. (The doctor wants a reading in two weeks.)

I think even Bob is getting convinced that he can adjust his Coumidin better than the Doctor.

BTW I have to take antibotics when I go to the dentist because I have a Knee replacement and the Ortho DR. prescribed some antibotic that I had to take over a three day period and they really upset my stomach. The kicker here is the Dentist was really surprised by the script and says she recommends the usual 4 pill 1hour before your appt. Think I'll go with the dentist next time.

Joan

 

[Harpoon]

Just to put my two cents in on this.

I'm taking the same dose everyone else is for the amoxicillin, 2000mg an hour before the exam.

However, I've been doing the prophylaxis thing for EONS and that doesn't hasn't always been the same, or even the same medication.


Chances are, if it's amox then it's the 2000mg, if it's something else, the dosage might be different.


I used to take two amoxicillin tabs (1000mg total) an hour before then 500mg every eight hours for the next four or five days after seeing the dentist (or orthodontist, I was in braces at the time.)

ASK why your cardiologist recommended a different dose for you and see what the dentist has to say as well.

My dentist is the one that writes my scrips for amoxicillin and I get a call an hour before my appointment from the secretary reminding me to take it...

They ask again when I show up at the office.

It's REALLY annoying, like they're all trying to be my mother or something, but then again it's cool because they're making sure I'm not going to get myself killed having my teeth cleaned.

 

[Bryan B]

I was told, no invasive procedures until 6 months post-op (including dental work). If I needed something done before 6 months that can't wait I am willing to bet they would presribe the IM/IV regimine before and the PO dose after. What this does is guarantee that the antibiotics are in the bloodstream (especially if they use IV) during the procedure. With oral meds there are too many things that can effect the absorbtion rate, and I was told that the first 6 months the valves are more vunerable to infection until the intimal linings of the valves have had a chance to heal.

If you're beyond 6 months post-op, it does seem like overkill to use injectable antibiotics unless there's something else going on that may raise your risk level.