From the Research
Patients with amyloid angiopathy do not typically require prophylactic antibiotics. Amyloid angiopathy is a condition where amyloid proteins deposit in the walls of blood vessels, particularly in the brain, increasing the risk of cerebral hemorrhage and stroke. This condition is not associated with an increased risk of infection that would warrant antibiotic prophylaxis. The main management focuses on controlling blood pressure, avoiding anticoagulants and antiplatelet agents when possible, and managing symptoms. Prophylactic antibiotics are generally reserved for conditions with high infection risk, such as certain cardiac abnormalities before dental procedures, prosthetic joints, or immunocompromised states. Since amyloid angiopathy is a non-infectious vascular condition, antibiotics would not provide benefit and could potentially lead to unnecessary side effects and contribute to antibiotic resistance, as seen in studies where vancomycin use was associated with an increased risk of acute kidney injury 1 and cardiovascular implantable electronic device infection 2.
The most recent and highest quality study on the topic of antibiotic prophylaxis, a 2023 trial published in The New England Journal of Medicine, found that the addition of vancomycin to cefazolin prophylaxis was not superior to placebo for the prevention of surgical-site infections in arthroplasty among patients without known MRSA colonization 3. This study highlights the importance of judicious use of antibiotics to avoid unnecessary side effects.
In the context of amyloid angiopathy, the focus should be on managing the condition's specific risks, such as cerebral hemorrhage, and not on unnecessary antibiotic use. Studies on cerebral amyloid angiopathy have emphasized the importance of diagnostic criteria, imaging biomarkers, and management strategies to decrease intracerebral hemorrhage risk 4, 5, without mentioning a role for prophylactic antibiotics. If the patient has other comorbidities that independently warrant antibiotic prophylaxis, those should be addressed separately from their amyloid angiopathy diagnosis.