Antibiotic Prophylaxis

Traditionally prophylaxis has been offered to all people undergoing invasive procedures, both dental and non-dental, who have pre-existing endocardial defects.

NICE (National Institute of Clinical Excellence), after a thorough review, found no evidence to support this practice and recommends that routine antibiotic prophylaxis is not used [1].

The current recommendation is to use prophylaxis only in cases where there is a procedure involving an area with active infection, and to promptly treat infections in patients who are at risk of developing infective endocarditis.

A quick reference guide is found on the NICE web site and a link to it can be found at the end of this session on the web resources page.

When to offer prophylaxis

Do not offer antibiotic prophylaxis against infective endocarditis:

• To people undergoing dental procedures
• To people undergoing non-dental procedures at the following sites [1]:
  • Upper and lower gastrointestinal tract
  • Genitourinary tract; this includes urological, gynaecological and obstetric procedures, and childbirth
  • Upper and lower respiratory tract; this includes ear, nose and throat procedures and bronchoscopy

Do not offer chlorhexidine mouthwash as prophylaxis against infective endocarditis to people at risk undergoing dental procedures.

Managing Infection

• Investigate and treat promptly any episodes of infection in people at risk of infective endocarditis to reduce the risk of endocarditis developing
• Offer an antibiotic that covers organisms that cause infective endocarditis if a person at risk of infective endocarditis is receiving antimicrobial therapy because they are undergoing a gastrointestinal or genitourinary procedure at a site where there is a suspected infection

Advice

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 non-medical procedures such as body piercing or tattooing

Learning bite

Routine antibiotic prophylaxis is no longer recommended