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Prophylaxis against infective endocarditis: summary of NICE guidance
  1. T Stokes1,
  2. R Richey1,
  3. D Wrayon2
  1. 1
    National Institute for Health and Clinical Excellence, Manchester, UK
  2. 2
    Glasgow Dental Hospital and School, Glasgow, UK
  1. Professor D Wray, University of Glasgow, Glasgow Dental Hospital and School, 378 Sauchiehall Street, Glasgow G2 3JZ, UK; D.Wray{at}

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Infective endocarditis is a rare condition with an incidence of less than 10 per 100 000 population/year. It is, however, associated with a high mortality and morbidity. Accepted clinical practice has been to use antibiotic prophylaxis in those at risk of infective endocarditis undergoing dental and certain non-dental interventional procedures, in the belief that this may prevent its development. The effectiveness of such antibiotic prophylaxis in humans is, however, not proved1 and the recent American Heart Association guideline2 recommends a much more limited role for antibiotic prophylaxis against infective endocarditis. This article summarises the most recent guidance from the National Institute for Health and Clinical Excellence (NICE) on antibiotic prophylaxis against infective endocarditis.3

In summary, this guideline recommends that antibiotic prophylaxis to prevent infective endocarditis should not be given to adults and children with structural cardiac defects at risk of infective endocarditis undergoing dental and non-dental interventional procedures. The basis for this recommendation is:

  • There is no consistent association between having an interventional procedure, dental or non-dental, and the development of infective endocarditis.

  • Regular tooth brushing almost certainly presents a greater risk of infective endocarditis than a single dental procedure because of repetitive exposure to bacteraemia with oral flora.

  • The clinical effectiveness of antibiotic prophylaxis is not proved.

  • Antibiotic prophylaxis against infective endocarditis for dental procedures is not cost effective and may …

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  • Competing interests: All authors were members of the Guideline Development Group for the NICE guideline for prophylaxis against infective endocarditis. TS was the NICE lead for the work, RR the lead systematic reviewer and DW chaired the Guideline Development Group. DW is a director with the Medical and Dental Defence Union of Scotland.

  • Funding: This summary was written by the Centre for Clinical Practice (Short Clinical Guidelines technical team) at the National Institute for Health and Clinical Excellence.

  • The multidisciplinary Guideline Development Group had members from the following professional groups: cardiology (N Brooks, J Gibb), cardiothoracic surgery (D Keenan), dentistry and oral medicine (D Franklin, M Fulford, R Oliver, D Wray), microbiology (K Orr, J Sandoe) and pharmacy (N Cooley). Two patient representatives were included in the group (A Keatley-Clarke, S Power). In addition, there were co-opted expert advisors from anaesthesiology, cardiac nursing, cardiology, dentistry, gastroenterology, microbiology, obstetrics and gynaecology, respiratory medicine, otorhinolaryngology and urology (see full version of the guideline). The Short Clinical Guidelines Technical Team comprised L Ayiku, E Banks, M Heath, R Richey, F Ruiz and T Stokes.

  • Declaration: A similar summary of this guideline has also been published in the BMJ 2008;336:770–1.

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  • Correction
    BMJ Publishing Group Ltd and British Cardiovascular Society