Most endocarditis prophylaxis no longer necessary: NICE guideline
Clinical Question
Is prophylaxis necessary for patients with structural cardiac defects undergoing dental or other procedures?Clinical Question
Bottom Line
The United Kingdom's National Institute for Health and Clinical Excellence (NICE) recommends antibiotic prophylaxis not be given to adults or children with structural cardiac defects undergoing dental and nondental procedures. Chlorhexidine mouthwash is also not recommended. The nondental procedures that do not require prophylaxis include upper and lower gastrointestinal tract procedures; upper and lower respiratory tract procedures; urologic, gynecologic, and obstetric procedures, including childbirth. These recommendations are more conservative than the latest American College of Cardiology/American Heart Association guidelines, described below. (LOE = 2b)Bottom Line
Reference
Stokes T, Richey R, Wray D; Guideline Development Group. Prophylaxis against infective endocarditis: summary of NICE guidance. Heart 2008;84(7):930-931. [PMID:18552226]Reference
Study Design
Practice guidelineStudy Design
Funding
GovernmentFunding
Setting
Various (guideline)Setting
Synopsis
Recommendations for the prevention of infective endocarditis have been built on a lot of postulated mechanisms and wishful thinking with little evidence to back them up. Although endocarditis is rare, its morbidity and mortality rates are high and the thought was to be safe rather than sorry. The risk of endocarditis, less than 10 per 100,000 per year, may even be less than the deaths associated with anaphylaxis to the antibiotics used to prevent it. Citing low cost-effectiveness and the lack of proof of effectiveness of antibiotic prophylaxis, the NICE committee no longer recommends antibiotic prophylaxis for patients with structural cardiac defects undergoing dental procedures. Upper and lower gastrointestinal tract, genitourinary tract, and respiratory tract procedures do not require prophylaxis. Childbirth also does not require prophylaxis. In contrast, the American College of Cardiology/American Heart Association, in a recent update, states endocarditis prophylaxis is "reasonable" -- a downgrade from "recommended" -- for patients at highest risk for adverse outcomes. These patients will have a prosthetic cardiac valve, previous infective endocarditis, or congenital heart disease either unrepaired or repaired with prosthetic material. Routine dental care does not require prophylaxis, according to this group, unless the procedure involves manipulation of the gingiva or perforation of the oral mucosa. They no longer recommend prophylaxis for nondental procedures (Circulation 2008;118:887-896).Synopsis
Most endocarditis prophylaxis no longer necessary: NICE guideline is a sample topic from the EE+ POEM Archive.
To view other topics, please log in or purchase a subscription.
Evidence Central is an integrated web and mobile solution that helps clinicians quickly answer etiology, diagnosis, treatment, and prognosis questions using the latest evidence-based research. Complete Product Information.
Citation
Barry, Henry, et al., editors. "Most Endocarditis Prophylaxis No Longer Necessary: NICE Guideline." EE+ POEM Archive, John Wiley & Sons, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/infoPOEMs/426571/all/Most_endocarditis_prophylaxis_no_longer_necessary:_NICE_guideline.
Most endocarditis prophylaxis no longer necessary: NICE guideline. In: Barry HH, Ebell MHM, Shaughnessy AFA, et al, eds. EE+ POEM Archive. John Wiley & Sons; 2019. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426571/all/Most_endocarditis_prophylaxis_no_longer_necessary:_NICE_guideline. Accessed March 29, 2023.
Most endocarditis prophylaxis no longer necessary: NICE guideline. (2019). In Barry, H., Ebell, M. H., Shaughnessy, A. F., & Slawson, D. C. (Eds.), EE+ POEM Archive. John Wiley & Sons. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426571/all/Most_endocarditis_prophylaxis_no_longer_necessary:_NICE_guideline
Most Endocarditis Prophylaxis No Longer Necessary: NICE Guideline [Internet]. In: Barry HH, Ebell MHM, Shaughnessy AFA, Slawson DCD, editors. EE+ POEM Archive. John Wiley & Sons; 2019. [cited 2023 March 29]. Available from: https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426571/all/Most_endocarditis_prophylaxis_no_longer_necessary:_NICE_guideline.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Most endocarditis prophylaxis no longer necessary: NICE guideline
ID - 426571
ED - Barry,Henry,
ED - Ebell,Mark H,
ED - Shaughnessy,Allen F,
ED - Slawson,David C,
BT - EE+ POEM Archive
UR - https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426571/all/Most_endocarditis_prophylaxis_no_longer_necessary:_NICE_guideline
PB - John Wiley & Sons
DB - Evidence Central
DP - Unbound Medicine
ER -