Original article
A quantitative assessment of pre-dental antibiotic prophylaxis for patients with mitral-valve prolapse

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Abstract

Because antibiotic prophylaxis for dental procedures in patients with mitral-valve prolapse (MVP) has been controversial, we performed a decision analysis to assess the costs and effects of the oral and parenteral penicillin regimens currently recommended for patients at high risk for bacterial endocarditis.

The analysis suggests that there is a very small risk of post-dental endocarditis in MVP (4.1 cases per 106 procedures) which is outweighed by a greater risk of fatal reactions to parenteral penicillin (15 deaths per 106 courses). Parenteral penicillin prophylaxis therefore causes a net loss of life. For oral penicillin the risk of a fatal reaction is lower (0.9 deaths per 106 courses). However, oral penicillin prophylaxis appears to spare life only in older adults with MVP and at an extremely high cost: Over $1 million must be spent to spare one year of life.

Personal preferences may still make antibiotic prophylaxis desirable for individual MVP patients. However, from a societal perspective, routine predental antibiotic prophylaxis for MVP is a very expensive preventive strategy.

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    This work was supported in part by Grant # HS04101 from the National Center for Health Services Research, OASH, and in part by the W. M. Keck Foundation Research Scholars Program of the Health Systems Management Center, Case Western Reserve University.

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