Harvard Heart Letter

Scaling back on antibiotics

Most people, even those with heart disease, don't need to take antibiotics before a routine dental or surgical procedure.

Since the 1950s, the American Heart Association (AHA) and other medical organizations have urged a sizable group of people to take antibiotics before having dental work, a colonoscopy, or other procedures that might dump bacteria into the bloodstream. A dose of penicillin, so the thinking went, could prevent infective endocarditis, a potentially serious infection of the lining of the heart. After a hard-nosed look at the latest evidence, an expert panel assembled by the AHA puts much more emphasis on taking care of your teeth and limits preprocedure antibiotics to a smaller group.

Infection from within

Infective endocarditis occurs when bacteria or fungi invade the slippery endocardium, the innermost layer of the heart's chambers. It isn't common, affecting only about 15,000 Americans a year. But it is potentially deadly, and hard to get rid of. The growing mat of microorganisms can erode heart tissue, making it prone to other infections. It can damage heart valves and lead to heart failure or rhythm problems. If a piece of the growth breaks away and slips into the bloodstream, it can cause a heart attack or stroke.

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