Review decision: 

This guideline is a full update to the 2008 short guideline (CG64) on the use of prophylaxis against infective endocarditis (IE). This 2015 update was triggered by a recent study suggesting that the incidence of IE may have been affected by the 2008 guidance. As a precaution, NICE has reviewed the evidence relating to the effectiveness of prophylaxis against IE and found no need to change any of the existing guidance. In addition, NICE concludes that the longstanding increase in the incidence of IE in the UK and other countries globally is not well understood and could be due to a number of factors.

The advice in this NICE guideline covers:

Patients who are at risk of infective endocarditis, specifically:

  • adults and children with certain problems affecting the structure of the heart (such as a replacement heart valve or hypertrophic cardiomyopathy)
  • adults and children who have previously had infective endocarditis (whether or not they have an underlying cardiac problem)
  • people having any of these procedures:

    - any dental procedure

    - any obstetric or gynaecological procedure, or childbirth

    - any procedure on the bladder or urine system

    - any procedure on the gullet, stomach or intestines

    - any procedure on the airways, including ear, nose and throat procedures and bronchoscopy (a test used to diagnose some lung problems).

It does not specifically look at:

  • people at risk of infective endocarditis who do not have heart problems (such as intravenous drug users)
  • people having procedures that aren't in the list above

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