527508
research-article2014
CPJXXX10.1177/0009922814527508Clinical PediatricsBarton and Simon
Letter to the Editor
Prophylactic Antibiotics: Ineffective or Inefficacious
Clinical Pediatrics 2014, Vol. 53(8) 813 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0009922814527508 cpj.sagepub.com
Lucy A. Barton, BS, PA-S1 and Michael W. Simon, MD, PhD2 Children with various congenital and acquired heart diseases benefit from improved care measures. These include surgical measures and outcomes as well as effective antibiotic prophylaxis. The recommendations have changed over the years, and the American Heart Association now recommends antimicrobial prophylaxis before dental procedures for patients with prosthetic heart valves, uncorrected congenital heart disease, valve repair with prosthetic material, leaflet pathology, a history of infectious endocarditis, and during the first 6 months after repair of a congenital heart defect.1 The rates of prosthetic valve endocarditis are 1% to 3% 1 year after valve replacement and are due to Staphylococcus aureus, coagulase negative staphylococci, gram negative bacilli, and fungal organisms within the first 2 postoperative months and streptococci, Staphylococcus aureus, coagulase-negative staphylococci, and enterococci after 2 months.2 The rate of endocarditis increases to 3% to 6% by 5 years after valve replacement.2 The mouth contains more than 700 species of bacteria.3 The most common is Viridans streptococci, comprising 30% of the microflora. Various β-lactamproducing bacteria, Staphylococcus aureus, and streptococci also inhabit the oral cavity.4 These bacteria may contribute to penicillin and cephalosporin resistance. The current recommendation for adult patients at risk for endocarditis is to receive 2 g of amoxicillin, whereas children at risk should receive 50 mg/kg of amoxicillin orally 30 to 60 minutes before a dental procedure.5 Despite these recommendations, amoxicillin resistance
among the microflora of the oral cavity is reported as 43%.5 Considering the current rate of endocarditis and the antibiotic resistance of the microflora in the oral cavity, it may be time to change the recommendations to use a β-lactam-resistant antibiotic in situations where antibiotic prophylaxis is indicated in children. References 1. Sexton DJ. Antimicrobial prophylaxis for bacterial endocarditis. http://www.uptodate.com/contents/anti microbialprophylaxis-for-bacterial-endocarditis. Published 2012. Accessed March 1, 2014. 2. Karchmer AW. Epidemiology, clinical manifestations, and diagnosis of prosthetic endocarditis. http://www.upto date.com/contents/epidemiology-clinical-manifestationsand-diagnosis-of-prosthetic-valve-endocarditis. Published 2013. Accessed March 1, 2014. 3. Aas JA, Paster BJ, Stokes LN, Olsen I, Dewhirst FE. Defining the normal bacterial flora of the oral cavity. J Clin Microbiol. 2005;43:5721-5732. 4. Handal T, Olsen I. Antimicrobial resistance with focus on oral beta-lactamases. Eur J Oral Sci. 2000;108:163-174. 5. Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association. J Am Dent Assoc. 2008;139:3-24.
1
Medical University of South Carolina, Charleston, SC, USA University of Kentucky, Lexington, KY, USA
2
Corresponding Author: Lucy A. Barton, 1352 Strawberry Lane, Lexington, KY 40502, USA. Email: [email protected]
Downloaded from cpj.sagepub.com at UCSF LIBRARY & CKM on March 17, 2015
research-article2014
CPJXXX10.1177/0009922814527508Clinical PediatricsBarton and Simon
Letter to the Editor
Prophylactic Antibiotics: Ineffective or Inefficacious
Clinical Pediatrics 2014, Vol. 53(8) 813 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0009922814527508 cpj.sagepub.com
Lucy A. Barton, BS, PA-S1 and Michael W. Simon, MD, PhD2 Children with various congenital and acquired heart diseases benefit from improved care measures. These include surgical measures and outcomes as well as effective antibiotic prophylaxis. The recommendations have changed over the years, and the American Heart Association now recommends antimicrobial prophylaxis before dental procedures for patients with prosthetic heart valves, uncorrected congenital heart disease, valve repair with prosthetic material, leaflet pathology, a history of infectious endocarditis, and during the first 6 months after repair of a congenital heart defect.1 The rates of prosthetic valve endocarditis are 1% to 3% 1 year after valve replacement and are due to Staphylococcus aureus, coagulase negative staphylococci, gram negative bacilli, and fungal organisms within the first 2 postoperative months and streptococci, Staphylococcus aureus, coagulase-negative staphylococci, and enterococci after 2 months.2 The rate of endocarditis increases to 3% to 6% by 5 years after valve replacement.2 The mouth contains more than 700 species of bacteria.3 The most common is Viridans streptococci, comprising 30% of the microflora. Various β-lactamproducing bacteria, Staphylococcus aureus, and streptococci also inhabit the oral cavity.4 These bacteria may contribute to penicillin and cephalosporin resistance. The current recommendation for adult patients at risk for endocarditis is to receive 2 g of amoxicillin, whereas children at risk should receive 50 mg/kg of amoxicillin orally 30 to 60 minutes before a dental procedure.5 Despite these recommendations, amoxicillin resistance
among the microflora of the oral cavity is reported as 43%.5 Considering the current rate of endocarditis and the antibiotic resistance of the microflora in the oral cavity, it may be time to change the recommendations to use a β-lactam-resistant antibiotic in situations where antibiotic prophylaxis is indicated in children. References 1. Sexton DJ. Antimicrobial prophylaxis for bacterial endocarditis. http://www.uptodate.com/contents/anti microbialprophylaxis-for-bacterial-endocarditis. Published 2012. Accessed March 1, 2014. 2. Karchmer AW. Epidemiology, clinical manifestations, and diagnosis of prosthetic endocarditis. http://www.upto date.com/contents/epidemiology-clinical-manifestationsand-diagnosis-of-prosthetic-valve-endocarditis. Published 2013. Accessed March 1, 2014. 3. Aas JA, Paster BJ, Stokes LN, Olsen I, Dewhirst FE. Defining the normal bacterial flora of the oral cavity. J Clin Microbiol. 2005;43:5721-5732. 4. Handal T, Olsen I. Antimicrobial resistance with focus on oral beta-lactamases. Eur J Oral Sci. 2000;108:163-174. 5. Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association. J Am Dent Assoc. 2008;139:3-24.
1
Medical University of South Carolina, Charleston, SC, USA University of Kentucky, Lexington, KY, USA
2
Corresponding Author: Lucy A. Barton, 1352 Strawberry Lane, Lexington, KY 40502, USA. Email: [email protected]
Downloaded from cpj.sagepub.com at UCSF LIBRARY & CKM on March 17, 2015
