The August edition of ‘Eyes on Evidence’, the free monthly e-bulletin from NHS Evidence covering major new evidence as it emerges with an explanation about what it means for current practice, includes an expert commentary on a recently published study that examined the impact of the recommendation by NICE (in clinical guideline 64) that routine antibiotic prophylaxis is not required before invasive dental procedures for patients at risk of infective endocarditis.  This study was reported on NeLM at the time of publication – please see the link below for further details.

According to the Commentary, “the NICE guidance on antibiotic prophylaxis virtually contradicted previous established clinical practice. This has caused considerable anxiety, particularly among cardiologists and especially regarding the management of patients perceived as being at the highest risk, such as those with a history of previous infective endocarditis or those with prosthetic valves.  This study reassures us that the huge reduction in antibiotic prophylaxis prescribing has not been associated with an epidemic of infective endocarditis and has caused no detectable change in the trend of the incidence of infective endocarditis. 

Recent papers published in the British Dental Journal (see links below) highlight the difficulties that have been encountered in practically implementing such a shift in clinical practice particularly when patients get conflicting advice from different health care professionals.  The authors concluded that dentists needed detailed knowledge of the evidence underpinning the guidance in order to obtain the trust of the patients who, in turn, needed to feel they were being treated on a case by case basis when treatment decisions were being made."

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