Letters to the Editor
Management of MVP with Antibiotic Prophylaxis
FREE PREVIEW Log in or buy this issue to read the full article. AAFP members and paid subscribers get free access to all articles. Subscribe now.
FREE PREVIEW Subscribe or buy this issue. AAFP members and paid subscribers get free access to all articles.
Am Fam Physician. 2001 Jul 1;64(1):36.
to the editor: In the article on management of mitral valve prolapse (MVP),1 the authors state that antibiotic prophylaxis is “recommended for most patients with definite diagnosis of mitral valve prolapse,” but do not lay out specific criteria for this. I wish to clarify this point.
The authors refer to the guidelines regarding valvular heart disease that were published in 1998.2 These guidelines reaffirm that a prophylactic antibiotic should be given to patients with MVP characterized by a systolic click and accompanying systolic murmur, as well as those with documented echocardiographic evidence of concomitant MVP and mitral regurgitation. Whether a prophylactic antibiotic should be given in the absence of a systolic murmur has been a matter of some debate. The American College of Cardiology/American Heart Association guidelines state:
Recommendations for Antibiotic Endocarditis Prophylaxis for Patients with MVP Undergoing Procedures Associated with Bacteremia*
The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication.
There has been some disagreement concerning whether patients with an isolated systolic click and no systolic murmur should undergo endocarditis prophylaxis. Patients with only a systolic click who have echocardiographic evidence of a higher-risk profile for endocarditis, such as leaflet thickening, elongated chordae, left atrial enlargement, or LV dilatation, should receive endocarditis prophylaxis.2
These recommendations are summarized in the accompanying table. As in the past, antibiotic prophylaxis is not recommended for patients with an isolated systolic click and no distinct echocardiographic evidence of MVP.
1. Bouknight DP, O' Rourke RA. Current management of mitral valve prolapse. Am Fam Physician. 2000;61:3343–50,3353–4.
2. ACC/AHA guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association. Task Force on Practice Guidelines. J Am Coll Cardiol. 1998;32:1486–588.
Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: firstname.lastname@example.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.
Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.
Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
Copyright © 2001 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact email@example.com for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions