Choosing Wisely:

Avoid prophylactic antibiotics for the treatment of mitral valve prolapse.

Rationale and Comments: Antibiotic prophylaxis is no longer indicated in patients with mitral valve prolapse for prevention of infective endocarditis. The risk of antibiotic-associated adverse effects exceeds the benefit (if any) from prophylactic antibiotic therapy. Limited use of prophylaxis will likely reduce the unwanted selection of antibiotic-resistant strains and their unintended consequences such as Clostridium difficile–associated colitis.
Sponsoring Organizations:
  • Infectious Diseases Society of America
  • Sources:
  • ACC/AHA guidelines
  • Disciplines:
  • Cardiovascular
  • Infectious disease
  • References: • Nishimura RA, Carabello BA, Faxon DP, Freed MD, Lytle BW, O’Gara PT, O’Rourke RA, Shah PM. ACC/AHA 2008 Guideline update on valvular heart disease: focused update on infective endocarditis: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008;52(8):676-85.
    • Gopalakrishnan PP, Shukla SK, Tak T. Infective endocarditis rationale for revised guidelines for antibiotic prophylaxis. Clin Med Res. 2009;7(3):63–8.

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