Infective endocarditis: the impact of the NICE guidelines for antibiotic prophylaxis.

UNLABELLED: Infective endocarditis (IE) is a serious, life-threatening disease and oral bacteria are implicated in 35-45% of cases. This has led to the development of guidelines recommending the use of antibiotic prophylaxis (AP) prior to invasive dental procedures in patients at risk of IE. There is considerable controversy about the value of AP in preventing IE, resulting in guideline changes and different guidelines in different parts of the world. In March 2008, NICE recommended the complete cessation of AP prior to dental procedures in the UK. The effects of this controversial change were not entirely as anticipated and may provide important lessons about the role of AP in preventing IE. CLINICAL RELEVANCE: The debate over the value of providing antibiotic prophylaxis to prevent infective endocarditis in patients undergoing invasive dental procedures is of importance to dentists worldwide. The effect of the NICE guidelines on antibiotic prophylaxis prescribing and incidence of infective endocarditis in the UK has contributed important new evidence to this ongoing debate.