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Antibiotic prescribing cut by three-quarters following NICE advice

8040970-article-dentistNICE guidance has helped to cut down on unnecessary antibiotic prescribing for the prevention of infective endocarditis, latest research suggests.

Antibiotic prophylaxis prescribing fell by 78.6 per cent following the introduction of NICE guidelines for infective endocarditis - an infection of the lining of the heart that is caused mainly by bacteria but occasionally by other infectious agents.

Despite advances in diagnosis and treatment, infective endocarditis remains a life-threatening disease with significant mortality of around 20 per cent.

Antibiotics have been offered routinely for more than 50 years as a preventative measure to people at risk of infective endocarditis.

However, there is little evidence to support this practice and any benefits from antibiotic prophylaxis need to be weighed against the risks of adverse effects for the patient and of developing antibiotic resistance.

As a result, NICE recommended in March 2008 that antibiotic prophylaxis should no longer be offered routinely for all patients at risk of infective endocarditis undergoing dental and a wide range of other invasive procedures.

Researchers, led by Professor Martin Thornhill, from the University of Sheffield, School of Clinical Dentistry, decided to assess the impact of the NICE guidelines by studying national prescribing data in England, as well as data recorded for all inpatient hospital activity in the UK.

They found that in the 12 months after the introduction of the NICE guideline, the prescribing of antibiotic prophylaxis for infective endocarditis declined rapidly.

In order to compare more stable periods of prescribing for antibiotic prophylaxis, the 12 months before the introduction of the guideline was compared with the most recent 12 months of prescribing data. This resulted in a 78.6 per cent reduction in antibiotic prescribing following the launch of the NICE guidelines.

The reduction in antibiotic use did not cause an increase in cases of infective endocarditis or in the number of deaths from the disease.

Writing in the British Journal of Medicine, the researchers say that the decrease in prescribing of antibiotics in the months after the introduction of the guideline was large and suggests much better compliance than is often seen after policy changes in medicine, with particularly good compliance among dentists.

They concluded that the findings “support the cessation of antibiotic prophylaxis before dental and other invasive procedures.”

The recommendations advising against the use of antibiotic prophylaxis to prevent infective endocarditis can also be found on the NICE website as part of the “do not do” database.

The database contains recommendations on clinical practices that should be discontinued completely or should not be used routinely in the NHS, and contains recommendations that have been made since 2007, taken from NICE cancer service guidance, clinical guidelines, interventional procedures and technology appraisals guidance.

6 May 2011

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.