Main points of the NICE guidelines on infective endocarditis (IE) prophylaxis that you need to know.
- Historically, patients were given antibiotic prophylaxis before any dental intervention if they were considered to be at risk of infective endocarditis. This was largely based on “expert advice” due to a lack of robust evidence
- Recent evidence suggests that:
- i) bacteraemias also arose during daily activities like toothbrushing,
ii) there was a lack of association with IE episodes and
iii) there was a lack of evidence proving the efficacy of antibiotic prophylaxis regimes.
- Antibiotic administration is not without risk to the individual patient, notwithstanding the implications of unnecessary antibiotic use on antimicrobial resistance.
- Evidence suggested that antibiotic prophylaxis regimens might result in a net loss of life
- At-risk patients undergoing interventional procedures should no longer be given antibiotic prophylaxis against IE.
- Chlorhexidine mouthwash should not be offered as prophylaxis against infective endocarditis to people at risk of infective endocarditis undergoing dental procedures.
- Healthcare professionals should offer people at risk of infective endocarditis clear and consistent information about prevention, including:
- the benefits and risks of antibiotic prophylaxis, and an explanation of why antibiotic prophylaxis is no longer routinely recommended
- the importance of maintaining good oral health
- symptoms that may indicate infective endocarditis and when to seek expert advice
- the risks of undergoing invasive procedures, including nonmedical procedures such as body piercing or tattooing.
For the full guidance, please visit the NICE website.