Antibiotics after heart surgery

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Submitted by Dr T on June 12, 2013 – 8:40pm

Question: 
Hi. In July of ’11, I had cardiac arrest and emergency quad bypass. All went well, and after discharge was NEVER set up any followup in the two years following. My primary care Dr. seems to think I’m doing well too. Now I have some teeth that need to be pulled so I can get a bottom denture, but my dentist says I have to get approval from my cardiologist first and be cleared for what they said was “pre meds”…antibiotics IN CASE I developed an infection. I’ve been on a few antibiotics in the last two years, one I know was while still in the hospital for the bypass, and one just a couple months ago when I was diagnosed with COPD. Could you please explain to me why the dentist says I need approval for an antibiotic because I simply don’t understand at all. Your explanation will be greatly appreciated as soon as you can get it to me. Things are all in an uproar between the two Dr’s and me in the middle not understanding why, and what steps I could do to speed things up. Thank you!
Hi Chuck,
As you can read in this list, there is no need for prophylactic antibiotic therapy after coronary artery bypass surgery, thus your dentist is incorrect. This is only necessary in case of a problem or procedure inside your heart such as a heart valve operation. 

Antibiotic prophylaxis is used to prevent an infection inside the heart (called Infective endocarditis) of susceptible patients. As an example, even a minor infection, such as a tooth abscess can cause severe bacterial endocarditis. However, recent recommendations for prophylactic antibiotic therapy before a procedure  in patients with heart valve and other cardiac diseases have changed and now include :

  • Infective endocarditis is more likely to result from exposure to random bacterial infections associated with daily activities than caused by dental, GI tract, or GU (Read: no orthopedic) procedures. 
  • Antibiotic prophylaxis is no longer indicated in many cardiac patients for prevention of Infective endocarditis.
However, your doctors are equally at fault for not following up on your coronary artery disease, which was not cured with the bypass procedure. Only the blood supply to your heart was improved, not the illness that caused it. It is vital that you modify your cardiac risk factors as much as possible by living a heart healthy lifestyle, but you should also have regular cardiac check-ups.
Hope this helps,

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