WARNING may be long and boring
WARNING may be long and boring
I've been reading Bobs post with interest and Lyns views too. It just seems remarkable to me that such firmly held views can change overnight? I've only had my valve 9 months but have been to the dentist several times over those months. I of course leant all about the importance of Antibiotic cover from them. There was absolutely no way they'd treat me, be it a filling or cleaning without cover, insisting it really wouldn't be worth the risk. Then I go in a couple of days ago and the very same dentist is saying, "no don't worry about it, we can no longer prescribe it and you're better off not risking taking it anyway" !? I just cant get my head around this massive shift of the goal posts ! It would be like me going to the nurse for my inr test and her casually saying "Oh no we've stopped the Warfarin thing now, it would seem it never did anything anyway".
It seems too black and white all round for my head to deal with .
That's pretty interesting, because when you first got your valve, the new recomendations (March 2008) had already been in place. I wonder why he changed his mind now
NOT that this means much but I thought it was interesting and it is just UK not elsewhere.
SO I was confused because I was pretty sure when the US changed their guidelines(2006) the UK did the same ones. Basically they didn't think PA prevented BE but to play it safe or make people more comfortable they would give them to the most at risk (previous BE, valves, some CHDs ect) but When this thread was started I went and read most (but not all it's 107 pages) of the NICE and saw they didn't recomend them at all.
http://www.nice.org.uk/nicemedia/pdf/CG64NICEguidance.pdf
SO it still bothered me, because I remember lots of discusions in 2006 on all my groups that have members all over. So I checked the NICE guideline and they started March 2008. SO I (since I never sleep and have no life) searched for the 2006 UK info and they DID origonally recomend it for the high risk (even tho they said it might not help)
http://jac.oxfordjournals.org/cgi/content/full/57/6/1035 from April 2006
High-risk cardiac factors requiring antibiotic prophylaxis
Previous infective endocarditis
Cardiac valve replacement surgery, i.e. mechanical or biological prosthetic valves
Surgically constructed systemic or pulmonary shunt or conduit
Dental procedures requiring antibiotic prophylaxis
All dental procedures involving dento-gingival manipulation
So I haven't read all of both guidelines, BUT the one thing that the 2008 NICE guidelines say they take into effect that all the other orgs don't is COST.
(bottom of page 11-12 of 107)
http://www.nice.org.uk/nicemedia/pdf/CG64NICEguidance.pdf
"Four clinical guidelines on the prevention of IE are discussed in subsequent sections: American Heart Association (AHA) 2007 (Wilson et al. 2007), British Society for Antimicrobial Chemotherapy (BSAC)
2006 (Gould et al. 2006), European Society of Cardiology (ESC) 2004 (Horstkotte et al. 2004) and British Cardiac Society (BCS)/Royal College of Physicians (RCP) 2004 (Advisory Group of the British Cardiac Society Clinical Practice Committee 2004).
The recommendations of these four guidelines, and where reported the rationale for their recommendations, have been considered by the GDG in the development of this guideline. However, it should be emphasised that the GDG has based its recommendations on an independent consideration of the available clinical and cost-effectiveness evidence and, where appropriate, expert opinion."
right before that on page 10 it says
Infective endocarditis (IE) is an inflammation of the endocardium, particularly affecting the heart valves, caused mainly by bacteria but occasionally by other infectious agents. It is a rare condition, with an annual incidence of fewer than 10 per 100,000 cases in the normal population. Despite advances in diagnosis and treatment, IE remains a life-threatening disease with significant mortality (approximately 20%) and morbidity.
The predisposing factors for the development of IE have changed in the past 50 years, mainly with the decreasing incidence of rheumatic heart disease and the increasing impact of prosthetic heart valves, nosocomial infection and intravenous drug misuse. However, the potentially serious impact of IE on the individual has not changed (Prendergast 2006).
Published medical literature contains many case reports of IE being preceded by an interventional procedure, most frequently dentistry. IE can be caused by several different organisms, many of which could be transferred into the blood during an interventional procedure. Streptococci, Staphylococcus aureus and enterococci are important causative organisms.
It is accepted that many cases of IE are not caused by interventional procedures (Brincat et al. 2006), but with such a serious condition it is reasonable to consider that any cases of IE that can be prevented should be prevented. Consequently, since 1955, antibiotic prophylaxis that aims to prevent endocarditis has been used in at-risk patients. However, the evidence base for the use of antibiotic prophylaxis has relied heavily on extrapolation from animal models of the disease (Pallasch 2003) and the applicability of these models to people has been questioned. With a rare but serious condition such as IE it is difficult to plan and execute research using experimental study designs. Consequently, the evidence available in this area is limited, being drawn chiefly from observational (case–control) studies
