I am confused about who needs antibiotics prior to dental work. Prophylaxis used to be for patients with mitral valve prolapse, and then mechanical valves/parts were added. Now I’m getting prescription requests for patients with all sorts of heart problems. Also, whose responsibility is it to prescribe antibiotics in this situation—the primary-care clinician or the dentist doing the procedures?
—Gail Dudley, DO, Umatilla, Fla.

You are not the only one who is confused. Guidelines on endocarditis prophylaxis in patients undergoing dental work are based on expert opinions rather than solid clinical data. With the greater number of cardiac diagnostic as well as surgical procedures today, the list of eligible patients has increased. The incidence and high mortality of endocarditis has remained about the same. Because of medicolegal concerns, any provider will offer patients the option of antibiotic prophylaxis. This may be the responsibility of the patient’s primary clinician as well as the dentist.
—Cedric W. Spak, MD (106-9)

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