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Medically Compromised Patients Medicine Supporting Your Practice

Are antibiotics needed for a patient who had a bypass surgery?

Editable vector background - heart and heartbeat symbol on refleThis question was submitted by a general dentist: Do I need to prescribe prophylactic antibiotic coverage before performing oral prophylaxis in a patient who has had a bypass surgery 1 year ago?

Dr. Suham Alexander provided this quick initial response.  


Patients at increased risk of infective endocarditis are prescribed prophylactic antibiotics prior to their dental appointment. This population of patients includes:

  • Patients who have prosthetic heart valves or heart valves which have been repaired with prosthetic material.
  • Patients with a history of endocarditis.
  • Heart transplant recipients with abnormal heart valve function.
  • Certain congenital heart defects such as:
    • Congenital heart defect repaired with prosthetic material or a device for the first 6 months after the repair was completed.
    • Repaired congenital heart disease with residual defects (persisting leaks, abnormal flow at or adjacent to a prosthetic valve or prosthetic device).
    • Cyanotic congenital heart disease which has not been repaired fully – includes children who have had surgical shunts and conduits.

If there are other questions or specific concerns, the patient’s physician or specialist should be contacted for further advice.


  1. http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/TheImpactofCongenitalHeartDefects/Infective-Endocarditis_UCM_307108_Article.jsp 
  2. http://www.cda-adc.ca/_files/position_statements/infectiousEndocarditis.pdf




  1. Matt Gilchrist November 4, 2014

    I feel that there is still so much confusion with prophylaxis rules. It is very difficult to just get a black and white answer. I think that these guidelines need to be rewritten for us to better understand.

    So back to the original question…does this patient need prophylaxis or not? I assume that if it is repaired back to proper function with no residual problems, then they should be okay without? What if this patient had the bypass surgery 6 months ago? Would they need it then? This is not stated anywhere in the guidelines.

    Also, where does a stent come into play? We all know that they need coverage for 6 months after placement, but nowhere is this stated in the guidelines. It does mention prosthetic material or a device for the first 6 months after the repair was completed, but this is under the heading of congenital defects.

    1. Peter Olejarz November 12, 2014

      A black and white answer is what we need. Not an excerpt from another publication. As far as stents were concerned, I was told that no prophylaxis is needed.

  2. John Day November 11, 2014

    I agree with the frustration we all experience with the lack of clarity in the guidelines. I had a situation recently of a patient after a 3rd ablation surgery. The patient would have had extensive scarring of his endocardium with, I assume, increased risk of endocarditis, but this is not mentioned as requiring antibiotic prophylaxis in the guidelines. I am finding ablation surgery is becoming much more common in the aging population.
    I believe we are premedicating more for legal liability reasons than medical reasons as we follow the U.S. guidelines. In my personal experience the only endocarditis I have seen followed a simple procedure where prophylaxis was taken.
    There must be enough historical data to make an analysis of risk/benefit of whether to premeditated at all.
    John Day

  3. Anonymous November 11, 2014

    Short answer is no they don’t.

  4. Dr J Hennessy November 11, 2014

    As long as people are feeding antibiotics by the shovel-full to healthy animals, it will be extremely difficult to convince me that I’m overusing these drugs in a potentially harmful situation…eg any heart abnormality, history of cardiac surgery or history of rheumatic fever.

  5. Doug November 11, 2014

    No, they do not require antibiotic prophylaxis for bypass surgery, even within the first six months as per the AHA guidelines. I feel the AHA has given specific guidelines for the practitioner to use compared to those of 25 years ago. Too long there has been an over use of antibiotics for prophylaxis of heart and joint conditions with very little evidence based data. It’s good to see the AHA coming out with a definitive guideline and subsequent revisions compared to those in the past. One may be more prudent to limit stressful procedures in the 6 months post surgery, but this will vary from patient to patient.

  6. David June 25, 2019

    I am so happy to get this post. This is a nice post. I read your post. Its helps to patient. This is great Thanks for publishing this post.


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