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Vol. 72. Issue 1.
Pages 96 (January 2019)
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Vol. 72. Issue 1.
Pages 96 (January 2019)
Letter to the Editor
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Prophylaxis of Infective Endocarditis in Dentistry: Analysis of the Situation After Almost a Decade of Clinical Practice Guidelines. Response
Análisis de la situación de la profilaxis de la endocarditis infecciosa en odontología tras casi una década de guías de práctica clínica. Respuesta
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Paula Anguitaa,b, Juan C. Castilloa, Manuela Herrerac, Manuel Anguitaa,b,
Corresponding author
manuelanguita@secardiologia.es

Corresponding author:
a Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
b Instituto Cardiodental, Córdoba, Spain
c Facultad de Odontología, Universidad de Sevilla, Sevilla, Spain
Related content
Rev Esp Cardiol. 2019;72:9510.1016/j.rec.2018.07.013
Iria Silva Conde, Francisco Torres-Saura, Alberto Alperi García, Jesús María de la Hera Galarza
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To the Editor,

We appreciate the interest and comments of Silva Conde et al. regarding our article.1 In fact, they published an article in 2012 in Revista Española de Cardiología on how closely dentists followed the recommendations on infectious endocarditis (IE) prophylaxis.2 Their results were similar to those of our study, carried out 6 years later.1 Indeed, we cited their study in a previous article in which we compared IE prophylaxis approaches in different healthcare professionals (dentists, primary care physicians, and cardiologists) in Cordoba.3

Prophylaxis should be avoided in patients with no indication (those with atrial fibrillation, stents, or coronary artery bypass grafting). However, in other situations such as native valve disease or mitral prolapse, we believe that caution should be exercised, as several very recent studies4,5 indicate a high risk of IE in these conditions. In one Spanish study,5 the incidence of Streptococcus viridans IE was higher in patients with a bicuspid aortic valve and mitral prolapse than in those with conditions considered moderate or high risk. Another study also reported a high incidence of IE after invasive procedures (transfusions, coronary surgery, bronchoscopy, dialysis),4 which contradicts current recommendations.

In conclusion, we should avoid misuse of antibiotics in situations that are clearly no-risk, but exercise caution in light of the new evidence that the risk of IE in moderate-risk cardiac disease (essentially valve disease and congenital heart disease) may be higher than previously thought.

References
[1]
P. Anguita, M. Anguita, J.C. Castillo, P. Gámez, V. Bonilla, M. Herrera.
Are dentists in our environment correctly following recommended guidelines for prophylaxis of infective endocarditis?.
Rev Esp Cardiol., 72 (2019), pp. 86-88
[2]
F. Torres, A. Renilla, J.P. Flórez, S. Secades, E.M. Benito, J.M. de la Hera.
Knowledge of infective endocarditis prophylaxis among Spanish dentists.
Rev Esp Cardiol., 65 (2012), pp. 1134-1135
[3]
F. Castillo, J.C. Castillo, P. Anguita, R. Roldán, P. Gámez, M. Anguita.
Do we follow recomendations on infective endocarditis prophylaxis? Differences between health professionals involved.
Aten Primaria, 49 (2017), pp. 198-200
[4]
I. Janzky, K. Gemes, S. Ahnve, H. Asgeirsson, J. Moller.
Invasive procedures associated with development of infective endocarditis.
[5]
I. Zefri-Reiriz, A. deAlarcon, P. Muñoz, et al.
Infective endocarditis in patients with bicuspid aortic valve or mitral valve prolapse.
J Am Coll Cardiol., 71 (2018), pp. 2731-2740
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Revista Española de Cardiología (English Edition)

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