UK to review guidelines on infective endocarditis prevention

Franziska Beier, Dental Tribune International

Wed. 5 June 2024

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LONDON, UK: Earlier this year, researchers from the University of Sheffield confirmed that dental patients at high risk of infective endocarditis (IE) should be given antibiotics before undergoing invasive dental treatment. Based on their findings, they urged the UK’s National Institute for Health and Care Excellence (NICE) to update the current guidelines, which do not recommend antibiotic prophylaxis for these patients. The UK and Sweden are the only countries in Europe to advise against the use of antibiotics in this regard. Now, NICE has confirmed that it will review the new data on prophylaxis against IE later this year.

In recent years, the University of Sheffield has conducted multiple studies on the link between IE and dental antibiotic prophylaxis. The researchers noted that there had been high compliance with the NICE guidelines since 2008, resulting in a decline in the use of antibiotics. This compliance is believed to have led to a significant increase in the incidence of IE. The studies further highlighted the importance of antibiotic prophylaxis for dental patients at high risk of IE, particularly before undergoing invasive procedures like extractions or oral surgery. The researchers stated that, when taken together, the reviewed studies support an association between invasive dental procedures and subsequent IE, particularly in high-risk patients.

According to the British Dental Journal, NICE is currently in the process of establishing a new prioritisation board, which will be responsible for deciding which guidelines should be updated. One critical criterion is the assessment of the necessity of NICE’s involvement in setting guidance on topics for which robust national or international guidelines already exist.

Prof. Jonathan Benger, newly appointed chief medical officer of NICE, commented: “I have agreed with the NICE surveillance team that we will review the current evidence relating to CG64 [NICE guideline on prophylaxis against infective endocarditis] later this year and decide whether the information that has become available since 2016 is sufficient to support the case for a further update of existing NICE guidance. If so, this will proceed to the prioritisation board for detailed consideration.”

In addition to reviewing the guidelines, it is anticipated that the prioritisation board will evaluate whether NICE’s limited resources are best allocated to developing new guidance on this topic or whether it would be more efficient to adopt or endorse existing high-quality guidelines. For example, guidelines from the European Society of Cardiology are already extensively followed by UK cardiologists.