What are the treatments for aortic stenosis? Part 2
Antibiotics to prevent endocarditis
You will normally be advised to take a short course of antibiotics if you have certain surgical procedures such as cystoscopy or colonoscopy. During these procedures, some bacteria may be 'pushed' into the bloodstream. The 'antibiotic cover' aims to kill any bacteria which may get into the bloodstream and helps to prevent endocarditis (described above). Most doctors who do these surgical procedures are aware of the need to recommend antibiotic cover to people with heart valve disease. The British Heart Foundation (contact details below) also lists a range of procedures that require antibiotic cover.
You will normally be advised to take a short course of antibiotics if you have certain surgical procedures such as cystoscopy or colonoscopy. During these procedures, some bacteria may be 'pushed' into the bloodstream. The 'antibiotic cover' aims to kill any bacteria which may get into the bloodstream and helps to prevent endocarditis (described above). Most doctors who do these surgical procedures are aware of the need to recommend antibiotic cover to people with heart valve disease. The British Heart Foundation (contact details below) also lists a range of procedures that require antibiotic cover.
Dental treatments: until recently, it has also been advised that people with heart valve disease should take antibiotic cover when they have dental treatment. However, a guideline published in 2006 from the British Society for Antimicrobial Chemotherapy (BSAC) says that this is not needed in most situations. Their information aimed at patients says:
"A BSAC group of experts has spent a lot of time carefully looking at whether dental treatment procedures are a possible cause of infective endocarditis (IE) [sometimes called bacterial endocarditis (BE)], which is infection of the heart valve. After a very detailed analysis of all the available evidence they have concluded that there is no evidence that dental treatment procedures increase the risk of these infections.
Therefore it is recommended that the current practice of giving patients antibiotics before dental treatment be stopped for all patients with cardiac abnormalities, except for those who have a history of healed IE, prosthetic heart valves and surgically constructed conduits.
The main reasons for this are the lack of any supporting evidence that dental treatment leads to IE and the increasing worry that administration of antibiotics may lead to other serious complications such as anaphylaxis (severe allergy) or antibiotic resistance.
The advice from the BSAC is that patients should concentrate on achieving and keeping a high standard of oral and dental health, as this does reduce the risk of endocarditis. Help for this will be provided by your Dental Professional."
However, this guideline is controversial. It has caused a lot of debate, especially from some cardiologists (heart doctors) and dentists who maintain that antibiotic cover is still needed for dental procedures. See references below for details of some articles that deal with this controversy. Your own doctor or dentist will advise for your own particular circumstance.
By Lucie Tobin
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