Letters to the Editor

Management of MVP with Antibiotic Prophylaxis

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:

TABLE
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.

REFERENCES

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: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

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