Too Few Heart Patients Take Antibiotics Before Dental Work
In 1997, the AHA revised its guidelines to clarify which patients should receive antibiotics, and to recommend a simpler dosing schedule so patients would be more likely to take them. "Despite the intensive efforts of the AHA ... to make its 1997 guidelines as user friendly as possible, misconceptions remain," says Thomas J. Pallasch, DDS, MS. Pallasch, a professor of pharmacology and periodontics at the University of Southern California School of Dentistry in Los Angeles, reviewed the study for WebMD.
For example, Pallasch explains that "[some] dental treatment procedures not associated with significant bleeding no longer require antibiotics ... even in the highest-risk patients, and [the dentist is] the one to make this decision."
Manning's study looked at about 200 patients seen at the Beth Israel Deaconess Medical Center in December 1997. As directed by the new AHA guidelines, all the study patients had an echocardiogram, a test that uses sound waves to look at the heart and its valves.
Almost half of the patients who took part in the study had abnormal echocardiograms, suggesting that they needed antibiotics before dental work. Almost 90% of the patients who were at high risk for heart infection were told by their doctors to use preventive antibiotics, but only 60% of those at moderate risk got this advice. About 25% of those at low risk of heart infection -- who the AHA guidelines say don't need antibiotics -- were instructed to take them.
"The problems with taking antibiotics when you don't need them are the inconvenience, the cost, and the risk of an allergic reaction," Manning says. "On the other hand, if you need antibiotics and don't take them, there could be a life-threatening complication."
When asked for his recommendations, Manning says: "If you're taking antibiotics and it's been awhile since your situation has been reviewed, you should ask your doctor if you still need them. If you've had an echocardiogram and you're not using antibiotics for dental procedures, you should ask your doctor to review the echocardiogram to see if you do need them."
Although most patients in Manning's study followed their doctor's advice to take antibiotics, 13% did not. Better education for both doctors and patients may allow more appropriate antibiotic use while avoiding misuse, the study says.