Research published in The Lancet last year suggested that rates of infective endocarditis had increased in England after NICE advised against giving antibiotics to prevent the infection.
After the introduction of the NICE guideline in 2008, antibiotic prescribing fell significantly from an average of 10,900 prescriptions per month from January 2004 to March 2008, to only 2,236 prescriptions per month from April 2008 to March 2013.
At the same time, rates of infective endocarditis rose by an extra 35 cases a month. This increase in the incidence of infective endocarditis was significant for both individuals at high risk of infective endocarditis and those not considered to be at risk.
However, there was no evidence to suggest a direct link between the two and the study researchers from the University of Sheffield stressed that there may be other reasons for the increase in infections.
In light of this paper, NICE felt it was important to assess any new evidence and carried out an immediate review of the 2008 guideline.
This evidence has been taken into account in the 2015 update of this guideline but is insufficient to warrant a change to the existing recommendations.
As a result, the updated guideline continues to state that antibiotic prophylaxis against infective endocarditis is not recommended:
- for people undergoing dental procedures
- for people undergoing non-dental procedures at the following sites:
- upper and lower gastrointestinal tract genitourinary tract; this includes urological, gynaecological and obstetric procedures, and childbirth
- upper and lower respiratory tract; this includes ear, nose and throat procedures and bronchoscopy.
There is limited evidence about the effectiveness of antibiotic prophylaxis in reducing the incidence of infective endocarditis in people at risk of developing infective endocarditis. Consequently, NICE makes a research recommendation for a randomised controlled trial with long-term follow-up comparing antibiotic prophylaxis with no antibiotic prophylaxis in adults and children with underlying structural cardiac defects undergoing interventional procedures.