Guidance amended on antibiotic prophylaxis for infective endocarditis

NICE has made a small but significant change to its guidance on the use of antibiotic prophylaxis against infective endocarditis in cardiac patients undergoing dental procedures.

In 2015 NICE had reaffirmed guidance in its 2008 guideline that antibiotic prophylaxis against infective endocarditis in at-risk heart patients is not recommended for patients undergoing dental treatment.

The 2015 re-think was in response to research published in The Lancet that suggested that rates of infective endocarditis had increased in England after NICE advised against giving antibiotics to prevent the infection. NICE decided to assess the research but found "insufficient evidence" to warrant a change to the existing recommendations.

But in July of this year NICE announced that the recommendation had been changed to say that dentists should not "routinely" give antibiotics to patients at risk of infective endocarditis during dental procedures. The new ruling allows flexibility so that dentists and cardiologists can recommend antibiotic cover when it is in the best interests of the patient.

Professor Martin Thornhill of the University of Sheffield’s School of Clinical Dentistry and one of the researchers questioning the 2008 guidance commented: "This change is most welcome. It lifts the ban on giving antibiotic prophylaxis to protect patients at risk of endocarditis and permits dentists and cardiologists to act in the best interests of patients at greatest risk of this devastating disease by providing them with the protection that is standard care in the rest of the world."

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