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:

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.