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Infection Control · single question

A patient is taking warfarin (INR 2.5) and also has an INR of 2.0 for a different patient needing extraction. What is the correct management for a patient with mitral valve prolapse WITH regurgitation?

  1. No antibiotic prophylaxis is necessary for MVP with regurgitation
  2. Prescribe 2g amoxicillin before extraction
  3. Prescribe 1g IV cefazolin
  4. Prescribe 500mg azithromycin
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Correct answer: A. No antibiotic prophylaxis is necessary for MVP with regurgitation

  • A. Correct. Per the 2007 AHA updated guidelines (and confirmed in subsequent updates), mitral valve prolapse (MVP) WITH OR WITHOUT regurgitation is NO LONGER an indication for antibiotic prophylaxis before dental procedures. Only specific high-risk cardiac conditions require prophylaxis (prosthetic heart valves, history of IE, certain congenital heart defects, cardiac transplant with valvulopathy).
  • B. 2g amoxicillin is the prophylaxis dose for HIGH-RISK cardiac conditions — MVP does not qualify.
  • C. IV cefazolin is for high-risk patients who cannot take oral medications — not indicated for MVP.
  • D. Azithromycin is the alternative prophylaxis for penicillin-allergic high-risk patients — MVP does not require prophylaxis.

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