BMJ  2008;336:976 (3 May), doi:10.1136/bmj.39563.556343.80

Letters

NICE on infective endocarditis

A call for national monitoring of antibiotic prophylaxis

The first 150 words of the full text of this article appear below.

The UK National Institute for Health and Clinical Excellence (NICE) recently published guidelines on antibiotic prophylaxis for preventing infective endocarditis in high risk patients with structural heart disease.^{1 2} The guidelines no longer recommend their use during dental and other invasive procedures of the respiratory tract, genitourinary tract, and upper and lower gastrointestinal tract—a considerable change from current practice. The guidelines apply to all high risk patients. The guidelines point to the lack of high quality evidence on whether antibiotics are effective in this situation or whether such procedures are linked to infective endocarditis. This was also highlighted in other recent guidelines,³ but they stopped short of recommending a change to current practice. This raises questions and anxiety in patients and those who treat them.

The report cites reactions to antibiotics (including anaphylaxis) as an argument against their use on a population scale, but in practice cardiologists can ask individual patients . . . [Full text of this article]

¹ Northampton General Hospital, Northampton NN1 5BD

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Prophylaxis against infective endocarditis: summary of NICE guidance

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