The National Institute of Health and Clinical Excellence (NICE) has published a clinical guideline on antibiotic prophylaxis against infective endocarditis (IE) for patients undergoing interventional procedures in primary dental care, primary medical care, secondary care or care in community settings.

In a significant change to current clinical practice, the guideline recommends that antibiotics to prevent IE should not be given to adults and children with structural cardiac defects at risk of IE who are undergoing dental and non-dental interventional procedures. According to NICE, the evidence suggests that antibiotic prophylaxis against IE for dental procedures is not cost effective and may lead to a greater number of deaths through fatal anaphylactic reactions than not using preventive antibiotics. The guideline makes the following recommendations (taken directly from source):
Healthcare professionals should regard people with the following cardiac conditions as being at risk of developing IE:

• acquired valvular heart disease with stenosis or regurgitation

• valve replacement

• 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

• previous IE

• hypertrophic cardiomyopathy.

Patients should not be offered antibiotics to prevent IE for any of the following procedures:

• a dental procedure

• an obstetric or gynaecological procedure, or childbirth

• a procedure on the bladder or urine system

• a procedure on the gullet, stomach or intestines

• a procedure on the airways, including ear, nose and throat and bronchoscopy.

Healthcare professionals should offer people at risk of IE 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 IE and when to seek expert advice

• the risks of undergoing invasive procedures, including non-medical procedures such as body piercing or tattooing.

People at risk of IE who are receiving antimicrobial therapy because they are undergoing a gastrointestinal or genitourinary procedure at a site where there is a suspected infection should be offered an antibiotic that covers organisms that cause IE.

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