Guidance

This guideline covers preventing infective endocarditis (IE) in children, young people and adults. It focuses on people at increased risk of infective endocarditis undergoing dental, gastrointestinal tract, genitourinary and respiratory tract procedures.

Last reviewed: 8 July 2016

Recommendations 1.1.1 and 1.1.2 were amended to clarify they apply to people at increased risk. ‘Routinely’ was added to recommendation 1.1.3 for consistency with recommendation 1.1.2. For more details, see update information.

This guideline updates and replaces NICE guideline CG64 (2008). The 2015 update was triggered by a study suggesting that the incidence of infective endocarditis may have been affected by the 2008 guidance. As a precaution, NICE reviewed the evidence relating to the effectiveness of prophylaxis against infective endocarditis and found no need to change any of the existing guidance. In addition, NICE concludes that the longstanding increase in the incidence of infective endocarditis in the UK and other countries globally is not well understood and could be due to a number of factors.

Next review: This guideline will be reviewed if there is new evidence that is likely to change the recommendations.

Recommendations

This guideline includes recommendations on:

Who is it for?

  • Healthcare professionals
  • Commissioners
  • Children, young people and adults, and their families and carers

Guideline development process

How we develop NICE guidelines

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 and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services 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 complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.