Abstract
The National Institute for Health and Care Excellence (NICE) has made an important change to Clinical Guideline 64 (CG64)1 adding the word ‘routinely’ to Recommendation 1.1.3: 'Antibiotic prophylaxis against infective endocarditis is not recommended routinely for people undergoing dental procedures.' In a letter about the change to the MP Chris Philp,2 Sir Andrew Dillon, CEO of NICE, confirmed that '… in individual cases, antibiotic prophylaxis may be appropriate.' This change followed approaches to Sir Andrew Dillon by Chris Philp and the widow of a patient with a replacement aortic valve who died from infe ctive endocarditis (IE) developing after unprotected dental scaling. Their case included: 1. Evidence that antibiotic prophylaxis is effective in people at high risk of IE having high risk dental procedures (Box 1). There are no randomised controlled trials. However, a French community study4 showed a 14-fold higher incidence of IE in people with replacement valves having unprotected dental procedures (1/10 700) compared with protected procedures (1/149 000). Horstkotte5 found no cases of IE in 229 people with replacement valves having protected dental procedures compared with 2 of 117 (1.7%) having unprotected procedures. A recent retrospective analysis of hospital-acquired data in the UK6 suggested that 277 patients at all levels of risk needed …
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