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Why is an antibiotic required before dental work? History of rheumatic fever. EKG normal

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General & Family Physician
Practicing since : 2001
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We lived in Kenya for 2yrs and while there in “06” my son XXXXXXX who was 6 at the time got rheumatic fever. The dentist requires that he takes antibiotic before teeth cleaning or any dental work. When we returned to the US we had his heart checked (I think it was an EKG the Dr. ordered) there was no sign of problems with his heart. My question is why the antibiotic before dental work & how long will he have to do that? Is there a possibility that something wrong could turn up with his heart years after getting rheumatic fever? If so how often should his heart be checked? Thank you
Posted Sat, 22 Sep 2012 in Child Health
Answered by Dr. Michelle Gibson James 1 hour later

Rheumatic fever is an autoimmune disease( body reacts against itself) that occurs in persons with a history of throat or skin infection with the bacteria group a strep. It causes inflammatory lesions in the heart, skin,joints and blood vessels.

According to the WHO , all persons who had an initial attack of rheumatic fever whether or not they have residual heart disease need to reciever antibiotics to prevent a second infection with group a strep. It is thought to reduce the chances of reccurrent infection with this bacteria and possible complications.Normally persons receive antibiotic therapy every 3 to 4 weeks.

There are some guidelines that have been established for persons with a history of rheumatic fever.

(1) A person who had rheumatic fever and carditis (inflammation of the heart that can occur in this illness) and still has remaining or residual heart disease after the acute episode resolved requires antibiotic treatment for a minimum of 10 yrs after the last episode.Prophylaxis is normally till at least 40 to 45 yrs and in most cases is continued for life
(2)A person who had carditis but has no residual heart disease should be on prophylaxis for at least 10 yrs or age 25 , which ever is later
(3)A person who did not have carditis and has no heart disease needs prophylaxis till age 18 or 5 yrs after the last attack, which ever is longer.

So your son should be on prophylactic therapy , the duration depends on if he had carditis and if he has any remaining heart issues. The prophylaxis is a long term therapy that should be administered every few weeks.This is to prevent Group a strep reoccurence.

In terms of the dentist, the american heart association has categories (high risk,moderate risk and low risk) to determine who needs antibiotics before dental procedures. Persons at high risk are those that require antibiotics. In the high risk category- persons with prosthetic valves, valve repair with prosthetic material,a prior history of infective endocarditis, congenital heart disease.
One of the categories in the low risk group (no antibiotics just prior) is previous rheumatic fever WITH NO valvular heart disease.

You need to consider speaking to your son's doctor and dentist regarding his prophylaxis and need for antibiotics prior to a dental visit.

I hope this information is helpful, feel free to ask any other questions

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