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.

In July 2016, ‘routinely’ was added to recommendation 1.1.3 for consistency with recommendation 1.1.2. This addition emphasises NICE’s standard advice on healthcare professionals’ responsibilities (see ‘your responsibility’ below).

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

This guideline was previously called prophylaxis against infective endocarditis: antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures.

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The application of the recommendations in this guideline is not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.

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