Infective endocarditis

Previously, in dentistry, antibiotics were prescribed as prophylaxis for the prevention of infective endocarditis. In 2008, the National Institute for Health and Care Excellence (NICE) issued Clinical Guideline 64 which stated that antibiotic prophylaxis against infective endocarditis was not recommended for people undergoing dental procedures.

In 2016 the National Institute for Health and Care Excellence (NICE) amended recommendation 1.1.3 of Clinical Guideline 64 Prophylaxis Against Infective Endocarditis (CG64) to include ‘routinely’ as follows:

Antibiotic prophylaxis against infective endocarditis is not recommended routinely for people undergoing dental procedures.

In 2018, SDCEP published advice for the dental team to help clarify and facilitate the implementation of the amended NICE guideline.

It was not NICE’s objective for the amended recommendation to result in a change in current practice, nor is it expected that the provision of antibiotic prophylaxis will change significantly following publication of SDCEP’s implementation advice. The vast majority of patients at increased risk of infective endocarditis will not be prescribed prophylaxis. However, for a very small number of patients, it may be prudent to consider antibiotic prophylaxis (non-routine management), in consultation with the patient and their cardiologist or cardiac surgeon.

SDCEP’s Antibiotic Prophylaxis Against Infective Endocarditis publication, which is available to download from the SDCEP website (www.sdcep.org.uk), offers practical advice on implementing NICE Clinical Guideline 64 in dental practice.

There is no evidence that prophylaxis is of any benefit in patients with prosthetic joints and it is unacceptable to expose patients to the potential adverse effects of antibiotics in these circumstances.