For the past 50 years, most people with heart conditions have received antibiotics before undergoing dental, gastrointestinal, or genitourinary procedures. It has been believed that the antibiotics prevent the development of bacteremia that could result in infective endocarditis-uncommon but often fatal or debilitating. Now, because there is no clear evidence to support antibiotic prophylaxis, and there are associated risks-allergic reactions and the possible development of drug-resistant bacteria-the American Heart Association has revised its guidelines. It now recommends antibiotic prophylaxis only in patients at high risk for severe illness or death if they contract endocarditis, such as people with prosthetic cardiac valves, a history of carditis or cardiac transplantation with cardiac valvulopathy, or certain types of congenital heart disease. Prophylaxis may be reasonable in these patients before "dental procedures that involve manipulation of the gingival tissue or the periapical region of teeth or perforation of the oral mucosa" or invasive procedures "that involve incision or biopsy of the respiratory mucosa," such as tonsillectomy or adenoidectomy.

Routine prophylaxis before gastrointestinal and genitourinary procedures is no longer recommended.

Fran Mennick, BSN, RN

NewsCAP

Migraines raise cardiovascular disease risk in men. According to a study published in the April 23 issue of Archives of Internal Medicine, men with migraines are at higher risk for cardiovascular disease, in particular heart attack, than are those without migraines. Between 1981 and 1984, 20,084 men, ages 40 to 54, who were free of heart disease enrolled in the Physicians Health Study and were followed for 16 years. Within five years, 1,449 men reported experiencing migraines. At follow-up, 2,236 major cardiovascular disease events occurred, including 1,046 heart attacks and 750 strokes. Compared with migraine-free men, migraineurs were 24% more likely to have major cardiovascular disease and 42% more likely to have a heart attack.