Guidance

Recommendations

Recommendations

People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care.

Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Adults and children with structural cardiac defects at risk of developing infective endocarditis

1.1.1

Healthcare professionals should regard people with the following cardiac conditions as being at increased risk of developing infective endocarditis:

  • acquired valvular heart disease with stenosis or regurgitation

  • hypertrophic cardiomyopathy

  • previous infective endocarditis

  • structural congenital heart disease, including surgically corrected or palliated structural conditions, but excluding isolated atrial septal defect, fully repaired ventricular septal defect or fully repaired patent ductus arteriosus, and closure devices that are judged to be endothelialised

  • valve replacement. [2015]

Patient advice

1.1.2

Healthcare professionals should offer people at increased risk of infective endocarditis clear and consistent information about prevention, including:

  • the benefits and risks of antibiotic prophylaxis, and an explanation of why antibiotic prophylaxis is no longer routinely recommended

  • the importance of maintaining good oral health

  • symptoms that may indicate infective endocarditis and when to seek expert advice

  • the risks of undergoing invasive procedures, including non‑medical procedures such as body piercing or tattooing. [2015]

Prophylaxis against infective endocarditis

1.1.3

Antibiotic prophylaxis against infective endocarditis is not recommended routinely:

  • for people undergoing dental procedures

    • For advice on antibiotic prophylaxis for people at high risk of infective endocarditis undergoing dental procedures and for relevant patient information, see the implementation advice provided by the Scottish Dental Clinical Effectiveness Programme (this programme is part of NHS Education for Scotland). This advice was developed in conjunction with, and is endorsed by, NICE. It has been endorsed for use across the UK by the Chief Dental Officers of the UK.

  • 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. [2015]

      The evidence reviews for this guideline covered only procedures at the sites listed in this recommendation. Procedures at other sites are outside the scope of the guideline (see the scope for details).

1.1.4

Chlorhexidine mouthwash should not be offered as prophylaxis against infective endocarditis to people at risk of infective endocarditis undergoing dental procedures. [2015]

Infection

1.1.5

Any episodes of infection in people at risk of infective endocarditis should be investigated and treated promptly to reduce the risk of endocarditis developing. [2015]

1.1.6

If a person at risk of infective endocarditis is receiving antimicrobial therapy because they are undergoing a gastrointestinal or genitourinary procedure at a site where there is a suspected infection, the person should receive an antibiotic that covers organisms that cause infective endocarditis. [2015]