NICE Advised to Change Antibiotic Guidelines for Dental Patients

An English study from the University of Sheffield reports the impact a change in guidelines had on the prescribing of antibiotic prophylaxis (AP) to prevent infective endocarditis in patients prior to undergoing invasive dental procedures. The study is reportedly the largest and most comprehensive research into the 2007 American Heart Association’s (AHA) recommendations that AP should continue to be given to patients at high risk of developing infective endocarditis, but not to those at moderate risk. Findings from the study, “Antibiotic Prophylaxis and Incidence of Endocarditis Before and After the 2007 AHA Recommendations,” have been published in the Journal of the American College of Cardiology.

The results led the team to declare the United Kingdom’s National Institute of Health and Care Excellence (NICE) was wrong to call for a complete ban on the use of AP before invasive dental treatment. Researchers found large drops in AP prescribing for those at moderate risk of  infective endocarditis (64%), and a 20% fall in in AP prescribing for patients at high risk (20%)—despite the AHA’s recommendation that those at high risk should continue to receive AP. They also identified a significant increase in infective endocarditis (177%) in those at high risk, but only a barely significant increase in those at moderate risk, according to the study.