Making the best of a risky situation

Dear Dr. Roach: I am 68 years old. A recent column discussed a woman on antibiotics for seven years, and I was concerned about my own situation. I had a knee replacement four years ago, and I had a severe staph infection afterward. I also have an artificial mitral heart valve, which added to my fears. I had a large hematoma, and I was on a wound vacuum and had to be infused with antibiotics three times a day for 45 days.

My infectious disease doctor kept me on 500 mg Keflex four times a day for the first year following my surgery. I seemy doctor and get my blood tested once a year. For the past three years, my doctor has prescribed 500 mg Keflex once a day. He has informedmethat he plans to keep me on this regimen for the rest ofmy life.

What are the benefits and risks associated with someone like me remaining on antibiotics for the rest ofmy life?— Anon.

There are some times when long-term antibiotics are appropriate, and one is when there is a suspicion of infected prosthetic materials that are difficult or unsafe to remove. This decision requires exceptional clinical skill and experience. I can’t question the infectious disease doctor who made the decision, as it sounds very reasonable to me. The issue is that there is a small risk of a catastrophic infection if you were to go off the antibiotics completely. Weighed against that are the small risks of long-term use of a generally safe antibiotic. Nobody wants to be in the situation you are in, but it sounds to me as though you and your doctor are making the best of it.

The concern I had with the previous letter writer’s situation is that the reasons for the long-term antibiotics weren’t clear, at least to me. I was very concerned that there was a serious infection or other problem that was not being appropriately looked for or treated.

Write to Dr. Roach at ToYourGoodHealth @med.cornell.edu