Overview of other guidelines

Overview of other guidelines

Before 2008 in the UK, antibiotic prophylaxis against infective endocarditis (IE) prior to invasive dental procedures was recommended practice for certain groups of patients with predisposing cardiac conditions. In 2008, the National Institute for Health and Care Excellence (NICE) issued Clinical Guideline 64 (CG64) on Prophylaxis against infective endocarditis which did not recommend antibiotic prophylaxis prior to dental procedures.²¹ The rationale for this was a lack of evidence to support the efficacy of antibiotic prophylaxis to prevent infective endocarditis, the risk of adverse events and antibiotic stewardship concerns. 

Most other international guideline committees, such as the European Society of Cardiology (ESC) and the American Heart Association (AHA), took a different view and recommended antibiotic prophylaxis prior to invasive dental procedures for patients at high risk of infective endocarditis, with the rationale that these patients tend to have worse outcomes from an episode of infective endocarditis.^19,23 

In 2016, NICE amended CG64 to state that antibiotic prophylaxis against infective endocarditis is not recommended routinely for people undergoing dental procedures, noting that this change was intended to convey the importance of shared decision-making. However, CG64 lacked information on the management of patients at risk of infective endocarditis and in 2018, the Scottish Dental Clinical Effectiveness Programme (SDCEP) published implementation advice to help dental teams apply the NICE recommendation.

In 2024, NICE added a statement to CG64 acknowledging that antibiotic prophylaxis may be appropriate for people at high risk of infective endocarditis undergoing dental procedures and directing users to SDCEP’s implementation advice.

The second edition of the SDCEP Antibiotic Prophylaxis Against Infective Endocarditis implementation advice is informed by NICE CG64, current guidelines from the ESC and AHA and by more recent evidence, and aims to assist dental teams in the UK to manage patients at risk of infective endocarditis.