NICE Guideline 64 does not recommend the routine use of antibiotic prophylaxis in invasive dental procedures to prevent infective carditis. Their guideline states that patients should only be offered it if the procedure is at a site where there is already a suspected infection.
This guidance caused some difficulties for dentists, as reported in the British Dental Journal in July. The conclusion was that dentists need to understand the evidence behind this recommendation to help them explain it to patients.
An observational study in the British Medical Journal has found no evidence of an increase in infective carditis since the reduction of routine antibiotic prophylaxis.
There is still a need for rigorous studies to identify the role of prophylaxis in patients at high risk of developing infective carditis.
This is a great article that follows up on a controversial change in prescribing habits. As a dentist, I would agree that the NICE guidelines caused some difficulties for dentists, and it was great to see the BMJ article show that there wasn’t a subsequent increase in the disease after we eased off the prescribing.
That said, when I get a letter from a cardiologist advising me to continue prophylactic measures for a patient, I don’t want to disagree with them – and to me that’s compatible with the conclusion (in the abstract)
“and further clinical trials should determine if antibiotic prophylaxis still has a role in protecting some patients at particularly high risk.”