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September 12, 1994

Myths of Dental-Induced Endocarditis-Reply

Author Affiliations

Wilmington, Del

Arch Intern Med. 1994;154(17):1994. doi:10.1001/archinte.1994.00420170142017

I appreciate Lebovitz's comments. As my article1 shows, there is considerable doubt that dental procedures cause or antibiotics prevent infective endocarditis, but there is no doubt that many patients receiving antibiotic prophylaxis will have untoward side effects from the antibiotics. There may, therefore, be higher risk from the antibiotics themselves than from the possibility of endocarditis without antibiotic prophylaxis. The question I pose to Lebovitz is not how to present the remote possibility of infective endocarditis to placebo patients but, rather, how to present the more likely possibilities of gastrointestinal upset, colonization of resistant and/or fungal strains, cross reactions with other drugs, hearing loss,2,3 infective endocarditis (from failure of antibiotic prophylaxis), allergy, anaphylaxis, and even death to at-risk patients under antibiotic cover. How does he reconcile giving uninfected patients drugs of known risks and costs but questionable benefit in preventing a usually nonfatal infection of unknown cause? A large-scale,

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