The National Institute for Health and Clinical Excellence has issued a new clinical guideline going against the common practice of using antibiotics to prevent infective endocarditis in at-risk patients undergoing certain interventional procedures.

Infective endocarditis is an inflammation of the inner lining of the heart caused by bacterial and other infections and, although rare, can be life threatening. Until now, it has been common clinical practice to give at-risk patients a course of antibiotics before they undergo certain dental or non-dental procedures, but the effectiveness of this prophylactic therapy had never been properly investigated.

After considering all the evidence, NICE has concluded that there is “no consistent association between having an interventional procedure and the development of IE”, and that “the clinical effectiveness of antibiotic prophylaxis is not proven”, and so recommends that antibiotics should not be given to adults and children for this purpose.

‘Not cost-effective’, NICE claims
Furthermore, the Institute claims the evidence indicates that antibiotic prophylaxis against IE for dental procedures is not cost effective, pointing out that it may actually put patients at greater risk of death from severe allergic reactions than not using antibiotics to prevent potential infection.

It is hoped that the new guideline, which, according to David Wray, Professor of Oral Medicine and Chair of the Guideline Development Group, represents a “fundamental change in clinical practice”, will help save the National Health Service in England and Wales around £1 million a year.