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Summary of Results

Health Topic:   Cardiovascular
Guidance:   Prophylaxis against infective endocarditis
Description:   The summary of the published clinical guideline on Prophylaxis against infective endocarditis . It links to the published guidance and key documents.

NICE implementation uptake reports

Implementation uptake report Assessment Published Date Coverage

External literature

External literature Assessment Coverage

Dayer M et al (2010) No significant increase in the incidence of infective endocarditis following the cessation of antibiotic prophylaxis European Heart Journal 31(Suppl),467

Description: The authors obtained monthly prescribing data for single doses of Amoxicillin or Clindamycin orally between January 2004-September 2009. They also accessed national inpatient hospital activity data between January 2000-September 2009. Results found that there was a 78% reduction in AP prescribing from 10,900 +/-1006 items per month pre March 2008 to 3496+/-1564 after. Between May and October 2009 the average was 2046+/-101 items.

Doubts about or mixed impact in practice National

Thornhill, M et al (2011) Impact of NICE guideline recommending cessation of antibiotic prophylaxis for prevention of infective endocarditis: before and after study British Medical Journal 2011:342:d2392

Description: All patients admitted to hospital in England with a primary or secondary discharge diagnosis of acute or subacute infective endocarditis were included in the scope of the study. Results found that after the introduction of the NICE guideline there was a significant reduction 78.6% reduction (P<0.001) in prescribing, from a mean 10,277 (SD 1068) prescriptions per month to 2292 (SD176).

Practice appears to be in line with guidance National

Farmer E et al (2011) Audit of current antibiotic prophylaxis against risk of infective endocarditis caused by dental procedures Heart Surgery Forum vol./is. 14/(S105), 1098-3511 (June 2011)

Description: 200 dental practices across the UK were surveyed. Results: 46.5% (93/200) responded. 96% (89/93) of the respondents recognized the existence of NICE guidelines. 37.5% (35/93) still prescribed prophylaxis to patients selectively. 46% (43/93) risk stratified cardiac surgical patients and prescribed to those deemed 'high risk'. 6% (5/93) of dentists prescribed prophylaxis to all pre- and post-op cardiac patients regardless of risk.

Doubts about or mixed impact in practice National

Kudiyirickal, MG. et al (2011) Antimicrobial prescribing practice by dentists: a study from two primary care centres in UK. Minerva Stomatologica. 60(10):495-500, 2011 Oct.

Description: This retrospective study analysed the types of orofacial infections for which antimicrobial agents were prescribed by dentists and also investigated variations in their usage from standard prescribing guidelines. Cases between January 2009 and December 2010 were selected at random from the clinical database of patients treated at two primary care dental practices in the West Midlands, UK. Non adherence to the prescribing guidelines was noticed in a majority (58%) of the 200 cases analysed.

Doubts about or mixed impact in practice Local

Farook, S.A. et al (2013) NICE guideline and current practice of antibiotic prophylaxis for high risk cardiac patients (HRCP) among dental trainers and trainees in the United Kingdom (UK). British Dental Journal. 213(4):E6, 2012 Aug.

Description: One of the aims of this study was to determine the understanding of the NICE guideline on antimicrobial prophylaxis against infective endocarditis (IE) amongst dental trainers and trainees. A proforma was completed by 70 dental trainers and 85 dental trainees attending a conference at the London deanery. Results show that 95.7% of the trainers and 94.1% trainees are aware of this guideline but compliancy with the guideline was low among both trainers (55.7%) and trainees (77.6%).

Doubts about or mixed impact in practice National

Dayer, M.J. et al (2013) NICE guidance on antibiotic prophylaxis to prevent infective endocarditis: a survey of clinicians' attitudes QJM. 2013 106 (3) pages 237-243

Description: Results are presented from a web based survey of dentists, cardiologists/ cardiothoracic surgeons and infection specialists undertaken to determine why there has been no significant change in the upward trend of antibiotic prophylaxis in cases of infective endocarditis, against NICE guidance. 1168 responses were received between January and April 2012. Results found 87% of dentists follow the guidance, compared to 39% of cardiologists/ cardiothoracic surgeons and 56% of infection specialists.

Doubts about or mixed impact in practice National

Darbyshire, R. et al (2012) Clinician understanding and compliance with NICE guidance regarding antibiotic prophylaxis for interventional procedures in children with congenital heart disease Arch Dis Child 2012 97: A131

Description: Results are presented from a follow-up audit of compliance to NICE guidelines for endocarditis prophylaxis at Addenbrookes Hospital, Cambridge. This follows a 2009 audit which suggested that over 33% of patients received antibiotics inappropriately. The study reviewed the management of 51 children with congenital heart disease undergoing a surgical procedure. Of these, 15 received intra-operative antibiotics. None were with a view to prophylaxis. Compliance with the NICE guidance was 100%.

Practice appears to be in line with guidance Local

This page was last updated: 18 September 2013

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

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