Methodology

This implementation advice was first published in 2018 in response to an amendment to the National Institute for Health and Care Excellence (NICE) Clinical Guideline 64 Prophylaxis against infective endocarditis (CG64).²¹ The methodology employed for the first edition of this implementation advice, published in 2018, is detailed below. Details of the methodology used to update the implementation advice for this second edition are also provided.

Development of the first edition (2018)

In 2016, NICE made an amendment to Clinical Guideline 64 Prophylaxis Against Infective Endocarditis (CG64). In response to this, SDCEP convened a Short-life Working Group to develop advice for the dental team to help clarify and facilitate the implementation of the amended NICE guideline. Re-appraisal of the evidence that underpinned the recommendations of CG64 was not within the scope of this work. Two guidelines from the European Society of Cardiology (ESC) and the American Heart Association (AHA) also informed the first edition of the implementation advice.

The resulting implementation advice was based on the recommendations in CG64, clinical guidelines from other professional organisations and a consensus of expert opinion. The prescribing information for adults was based on the antibiotic prophylaxis regimens from the 2006 British Society for Antimicrobial Chemotherapy report (BSAC)⁴⁵ while the antibiotic prophylaxis regimens for children were based on the 2015 ESC guideline.

The first edition of the implementation advice was subject to open consultation for a seven-week period. All comments received through the consultation process were reviewed, the feedback was considered by the Working Group, and the advice was amended accordingly prior to publication.

Development of the second edition (2026)

In 2024, NICE carried out an evidence surveillance review and made a further clarification to NICE CG64. This prompted a review of the SDCEP implementation advice. The Short-life Working Group was reconvened and expanded to ensure wider representation of relevant stakeholders. The review of the implementation advice did not reassess the evidence used by the NICE guideline committee or the evidence identified in NICE’s 2024 surveillance report.²² However, recent evidence related to the risk of infective endocarditis following different dental procedures was independently appraised by Cochrane Oral Health and presented to the Short-life Working Group to inform the classification of ‘at-risk’ dental procedures. Updated guidelines from the European Society of Cardiology (ESC) and the American Heart Association (AHA) also informed the review of the implementation advice.^19,23 Prescribing advice for adults and children was informed by the updated 2023 ESC guideline and adapted for UK practice based on expert opinion.

In addition, the Short-life Working Group heard personal stories from people affected by infective endocarditis, including a patient who developed infective endocarditis and the families of patients who have died of infective endocarditis. The Short-life Working Group would like to express their gratitude and appreciation to those who shared their personal experiences.

Targeted external expert review of the second edition of the implementation advice took place in November 2025. Individuals and organisations with expertise or experience of the topic were asked to comment on the applicability and suitability of the implementation advice to the intended audience. All comments received were considered by the Short-life Working Group, and the advice was amended accordingly prior to publication. The Short-life Working Group would like to thank all expert reviewers for their feedback.

Equality impact assessment

An assessment of the potential impact of this advice on equality target groups was conducted in 2018 and updated for the second edition.

Review and updating

A review of this implementation advice will take place when NICE Clinical Guideline 64 Prophylaxis against infective endocarditis is next updated.