Prophylaxis against infective endocarditis: antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures

Context

Infective endocarditis is a rare condition with significant morbidity and mortality. It may arise after bacteraemia in a person with a predisposing cardiac lesion.

In the past, people at risk of infective endocarditis were given antibiotic prophylaxis before dental and certain non‑dental interventional procedures. However, Gould et al. (2006) and Wilson et al. (2007) recommended changes in clinical practice that aimed to limit the use of antibiotic prophylaxis in people having these procedures.

In 2008 NICE published a guideline to give clear, evidence‑based guidance on best clinical practice for prophylaxis against infective endocarditis in people having dental and certain non‑dental interventional procedures. The guideline recommended that people at risk of infective endocarditis having interventional procedures (dental procedures, upper and lower respiratory tract procedures, upper and lower gastrointestinal tract procedures, genitourinary tract procedures) should not be offered antibiotic prophylaxis against infective endocarditis. It also recommended which patients with pre‑existing cardiac lesions should be regarded as at risk. These recommendations marked a further change from accepted practice.

The incidence of infective endocarditis has been shown to be increasing over time. The reasons for this are not well understood. However, in 2014 the Lancet published a paper that reported an increase in cases of infective endocarditis from 2000 to 2013, which showed a higher rate of increase following the publication of the NICE guideline (Dayer et al. 2015). In light of this paper, NICE felt it was important to assess any new evidence published since the 2008 NICE guideline. This evidence has been taken into account in the 2015 update of this guideline.