Medical Emergencies · patient case question
A different patient with an unrepaired congenital heart murmur presents for scaling. What antibiotic prophylaxis is indicated?
Patient case: Medical Emergency in the Operatory
demo: 34-year-old female
chief: Composite restoration on tooth #3 under rubber dam isolation.
history: Asthma, well controlled. No known drug allergies. Latex sensitivity not previously documented.
meds: Albuterol inhaler as needed
findings: Ten minutes after rubber dam placement the patient develops audible wheezing, swelling of the lips and periorbital tissue, and urticaria over the neck.
Show answer and explanation
Correct answer: A. None — an isolated unrepaired murmur is not a qualifying condition
- A. Correct. Current AHA guidance limits prophylaxis to prosthetic valves or material, previous infective endocarditis, certain unrepaired or incompletely repaired cyanotic congenital heart disease, and cardiac transplant valvulopathy. A murmur alone does not qualify.
- B. Azithromycin is an alternative agent, but the premise — that prophylaxis is needed — is wrong.
- C. Clindamycin is a penicillin-allergy alternative, again only when prophylaxis is warranted.
- D. Amoxicillin is the correct drug when prophylaxis is indicated, but here it is not indicated.
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