Are Prophylactic Antibiotics Necessary?

This article from the Washington Post addresses an issue that we frequently see:  Whether or not prophylactic antibiotics are necessary.  Various implants, such as heart valves and joint replacements have become very common so this issue is quite significant.  While it might seem to make good sense for such patients to take antibiotics before dental or other procedures, there are concerns both for the individual patient and the general population.  At the most basic level, antibiotics are not benign drugs.  Patients can have allergic reactions and there are other side effects.  On a larger scale, the concern about bacteria resistant to antibiotics is a huge risk.  Obviously, there is a risk benefit analysis in such treatment decisions, but as the article points out there does not seem to be much consensus among healthcare providers about the long term need for prophylactic antibiotic treatment.  This is a reminder that there are often unsettled questions in medicine.  What was standard of care treatment even five or ten years ago may be unacceptable now.  Things change.  That is about the only certainty there is.