Prophylaxis Against Infective Endocarditis: Antimicrobial Prophylaxis Against Infective Endocarditis in Adults and Children Undergoing Interventional Procedures [Internet]

Excerpt

Infective endocarditis (IE) is a rare condition with significant morbidity and mortality. It may arise following bacteraemia in a patient with a predisposing cardiac lesion. In an attempt to prevent this disease, over the past 50 years, at-risk patients have been given antibiotic prophylaxis before dental and certain non-dental interventional procedures.

In the absence of a robust evidence base, antibiotic prophylaxis has been given empirically to patients with a wide range of cardiac conditions including a history of rheumatic fever. The efficacy of this regimen in humans has never been properly investigated and clinical practice has been dictated by clinical guidelines based on expert opinion.

Recent guidelines by the British Society for Antimicrobial Chemotherapy and the American Heart Association have challenged existing dogma by highlighting the prevalence of bacteraemias that arise from everyday activities such as toothbrushing, the lack of association between episodes of IE and prior interventional procedures, and the lack of efficacy of antibiotic prophylaxis regimens.

Against this background, the Department of Health asked the National Institute for Health and Clinical Excellence (NICE) to produce a short clinical guideline which would give clear guidance on best clinical practice for prophylaxis against IE in patients undergoing dental and certain non-dental interventional procedures.