Patients at risk of infective endocarditis

Patients at risk of infective endocarditis

NICE Clinical Guideline 64 (CG64)²¹ states that antibiotic prophylaxis against infective endocarditis (IE) is not recommended routinely for people undergoing dental procedures. However, NICE acknowledges that there is a group of individuals for whom antibiotic prophylaxis may be of benefit.

The 2023 European Society of Cardiology (ESC) guideline¹⁹ identifies several categories of high risk patients (see High risk patients), for whom antibiotic prophylaxis is recommended or should be considered. It also lists a group of moderate risk patients (see Moderate risk patients) for whom antibiotic prophylaxis is not recommended. 

The identification and assessment of high risk and moderate risk patients will require liaison with their cardiac team(s) or general medical practitioner. The number of patients that fall within the high risk group is likely to be small and therefore most dental practices would be expected to have very few of these individuals registered.

Note that if a patient has a cardiac condition or has undergone a cardiac procedure that is not listed, for example insertion of a stent, they are not considered to be at high or moderate risk of IE and antibiotic prophylaxis is not required.

For advice on prevention of IE and the management of these patients, see Prevention of infective endocarditis and Management of patients at increased risk of infective endocarditis.

For further explanation of the cardiac terms used in this implementation advice, see Glossary of cardiac terms.