Excerpt

Infective endocarditis (IE) is a rare condition with significant morbidity and mortality. It may arise following bacteraemia in a patient with a predisposing cardiac lesion. In an attempt to prevent this disease, over the past 50 years, at-risk patients have been given antibiotic prophylaxis before dental and certain non-dental interventional procedures.

In the absence of a robust evidence base, antibiotic prophylaxis has been given empirically to patients with a wide range of cardiac conditions including a history of rheumatic fever. The efficacy of this regimen in humans has never been properly investigated and clinical practice has been dictated by clinical guidelines based on expert opinion.

Recent guidelines by the British Society for Antimicrobial Chemotherapy and the American Heart Association have challenged existing dogma by highlighting the prevalence of bacteraemias that arise from everyday activities such as toothbrushing, the lack of association between episodes of IE and prior interventional procedures, and the lack of efficacy of antibiotic prophylaxis regimens.

Against this background, the Department of Health asked the National Institute for Health and Clinical Excellence (NICE) to produce a short clinical guideline which would give clear guidance on best clinical practice for prophylaxis against IE in patients undergoing dental and certain non-dental interventional procedures.

Contents

• Foreword
• 1. Summary
  • 1.1 List of all recommendations
  • 1.2 Overview
• 2. Evidence review and recommendations
  • 2.1 People with cardiac conditions and their risk of developing infective endocarditis
  • 2.2 Bacteraemia: interventional procedures and infective endocarditis
  • 2.3 Interventional procedures associated with risk of developing infective endocarditis
  • 2.4 Levels of bacteraemia associated with interventional procedures and everyday activities
  • 2.5 Antibiotic prophylaxis to prevent infective endocarditis
  • 2.6 Patient perspectives on prophylaxis against infective endocarditis
  • 2.7 Research recommendations
• 3. Glossary and abbreviations
  • 3.1 Glossary
  • 3.2 Abbreviations
• 4. Methods
  • 4.1 Aim and scope of the guideline
  • 4.2 Development methods
• 5. Contributors
  • 5.1 The Guideline Development Group
  • 5.2 Declarations
• 6. Appendices
  • 6.1 Appendix 1 The scope
  • 6.2 Appendix 2 Key clinical questions
  • 6.3 Appendix 3 Search strategies
  • 6.4 Appendix 4 Evidence flow charts and evidence tables
  • 6.5 Appendix 5 References
  • 6.6 Appendix 6 De novo economic analysis
  • 6.7 Appendix 7 Health economics evidence tables

NICE clinical guidelines are recommendations about the treatment and care of people with specific diseases and conditions in the NHS in England and Wales

This guidance represents the view of the Institute, which was arrived at after careful consideration of the evidence available. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. The guidance does not, however, override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer and informed by the summary of product characteristics of any drugs they are considering.