25 May 2017
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NICE Guidelines you need to know: CG64 Prophylaxis against Infective Endocarditis

NICE Guidelines you need to know: CG64 Prophylaxis against Infective Endocarditis

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.