NICE Guidelines on prophylaxis against infective endocarditis 2015

In 2008 the National Institute for Health and Care Excellence published a guideline (CG64) on prophylaxis against infective endocarditis. The 2015 guideline on the same topic updates and replaces the 2008 publication. The guidelines are called Prophylaxis against infective endocarditis: antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures.

The Major Recommendations of the guidelines are as follows:-

Adults and Children with Structural Cardiac Defects at Risk of Developing Infective Endocarditis

Healthcare professionals should regard people with the following cardiac conditions as being at 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

Healthcare professionals should offer people at 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

Antibiotic prophylaxis against infective endocarditis is not recommended:

• For people undergoing dental procedures


• For people undergoing non-dental procedures at the following sites1:
  
  
  
  • 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]
  
  
  
  

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

1The 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.

Infection

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]

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]

 

For details of the guidelines click on the following link

CG64 NICEguideline on Prophylaxis against infective endocarditis