Saturday, March 14, 2009

Poll closed for IE prophylaxis awarness

Poll closed for IE prophylaxis awareness;

Had you changed your protocol in prophylaxis against IE?

and here is the summary of messgae we need to give for our visitors:

Patient asks his doctor: In the past, I have been given antibiotics to prevent infective endocarditis for the same procedure but have not been offered them now. Why this had been changed?

*We speculate that some clinicians and some patients and families still feel more comfortable continuing with prophylaxis for infective endocarditis.
*In those settings, the clinician should determine that the risks associated with antibiotics are low before continuing a prophylaxis regimen. Over time, and with continuing education, the committee anticipates increasing acceptance of the new guidelines among both provider and patient communities.
* Physicians should support the use of echocardiography in endocarditis prophylaxis decision making. However, the importance of echocardiography relative to other factors varies across physician specialties.
*The authors do not recommend prophylaxis solely on the basis of an increased risk of infective endocarditis.

The major changes in the updated recommendations included the following:

• The committee concluded that only an extremely small number of cases of infective endocarditis may be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100 percent effective.
• Infective endocarditis prophylaxis for dental procedures is reasonable only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis.
• For patients with these underlying cardiac conditions,prophylaxis is reasonable for all dental procedures that involve manipulation of either gingival tissue or the periapical region of teeth or perforation of oral mucosa.
• Prophylaxis is not recommended solely on the basis of an increased lifetime risk of acquisition of infective endocarditis.
• Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a GU or GI tract procedure.

The rationale for these revisions is based on the following:

• Infective endocarditis is more likely to result from frequent exposure to random bacteremias associated with daily activities than from bacteremia caused by a dental, GI tract, or GU procedure.
• Prophylaxis may prevent an exceedingly small number of cases of infective endocarditis (if any) in individuals who undergo a dental, GI tract, or GU procedure.
• The risk of antibiotic-associated adverse effects exceeds the benefit (if any) from prophylactic antibiotic therapy.
• Maintenance of optimal oral health and hygiene may reduce the incidence of bacteremia from daily activities and is more important than prophylactic antibiotics for a dental procedure to reduce the risk of infective endocarditis.
*Antibiotic prophylaxis is no longer indicated in patients with aortic or mitral stenosis, in adolescents and young adults with congenital valvular heart disease, or in patients with symptomatic or asymptomatic mitral valve prolapse.

*The committee notes that these abrupt changes in the AHA guidelines "may cause consternation among patients," and they advise clinicians "to discuss the rationale for these new changes with their patients, including the lack of scientific evidence to demonstrate a proven benefit for infective endocarditis prophylaxis."

*They also "understand" that clinicians may want to continue administering prophylaxis for patients with bicuspid aortic valve or coarctation of the aorta, severe mitral valve prolapse, or hypertrophic obstructive cardiomyopathy.

Endocarditis prophylaxis is not recommended for:
• Routine anesthetic injections through noninfected tissue
• Dental radiographs
• Placement or removal of prosthodontic or orthodontic appliances
• Adjustment of orthodontic appliances
• Placement of orthodontic brackets
• Shedding of deciduous teeth
• Bleeding from trauma to the lips or oral mucosa

I power

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