What is the role of Antibiotic (Antimicrobial) Prophylaxis in patients with Mitral Valve Prolapse (MVP)?

From the Guidelines

Antibiotic prophylaxis is no longer indicated in all patients with mitral valve prolapse for prevention of infective endocarditis. The current guidelines, as stated in the 2008 ACC/AHA guideline update on valvular heart disease 1, suggest that antibiotic prophylaxis is not necessary for all patients with mitral valve prolapse. This recommendation is based on the low overall risk of endocarditis and concerns about antibiotic resistance.

However, it is essential to note that certain high-risk features may necessitate antibiotic prophylaxis in some patients. These features include:

• Presence of mitral regurgitation
• Thickened leaflets
• History of previous endocarditis For these high-risk patients, antibiotic prophylaxis is recommended before certain dental procedures or invasive respiratory tract procedures. The standard regimen is:
• Amoxicillin 2g orally, taken as a single dose 30-60 minutes before the procedure. For patients allergic to penicillin:
• Clindamycin 600mg orally, taken as a single dose 30-60 minutes before the procedure, as supported by the guidelines 2.

The rationale for this recommendation is to prevent infective endocarditis in individuals at higher risk. The antibiotic aims to reduce the likelihood of bacteria entering the bloodstream during these procedures and adhering to the abnormal valve tissue. It's crucial to limit antibiotic prophylaxis to patients with specified high-risk features and procedures with a higher risk of bacteremia, as stated in the guidelines 1, 2.

From the Research

Role of Antibiotic Prophylaxis in Mitral Valve Prolapse (MVP)

The use of antibiotic prophylaxis in patients with Mitral Valve Prolapse (MVP) has been a topic of discussion in the medical community. Key points to consider include:

• The American Heart Association recommended antibiotic prophylaxis for patients with MVP and mitral insufficiency prior to procedures that place them at risk for bacterial endocarditis 3.
• A quantitative analysis suggested that the benefits and risks of antibiotic prophylaxis for patients with MVP undergoing dental procedures should be carefully considered, with estimated cases of bacterial endocarditis and deaths due to drug reactions 4.
• Some studies recommend that all MVP patients receive correct prophylactic treatment, regardless of whether they have mitral regurgitation or not 5.

Risks and Benefits of Antibiotic Prophylaxis

The risks and benefits of antibiotic prophylaxis for patients with MVP include:

• The risk of bacterial endocarditis, which can be serious and even fatal 6.
• The risk of fatal reactions to antibiotic prophylaxis, which can outweigh the benefits of prophylaxis in some cases 4, 7.
• The cost of antibiotic prophylaxis, which can be high and may not be justified from a societal perspective 7.

Clinical Considerations

Clinical considerations for antibiotic prophylaxis in patients with MVP include:

• The type of procedure being performed and the risk of bacteremia 3, 6.
• The patient's individual risk factors, such as mitral regurgitation or other cardiac lesions 3, 5.
• The potential for antibiotic resistance and the need for alternative prophylaxis regimens 6.