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Practice Guidelines

Prophylaxis against infective endocarditis: summary of NICE guidance

BMJ 2008; 336 doi: (Published 03 April 2008) Cite this as: BMJ 2008;336:770
  1. Roberta Richey, technical analyst1,
  2. David Wray, professor of oral medicine2,
  3. Tim Stokes, associate director1
  4. on behalf of the Guideline Development Group
  1. 1National Institute for Health and Clinical Excellence, Manchester M1 4BD
  2. 2Glasgow Dental School, Glasgow G2 3JZ
  1. Correspondence to: D Wray d.wray{at}

Why read this summary?

Infective endocarditis is a rare condition with a high mortality and morbidity. Accepted clinical practice has been to use antibiotic prophylaxis in those at risk of infective endocarditis who are having dental and certain non-dental interventional procedures, in the belief that this may prevent the development of infective endocarditis. The effectiveness of such antibiotic prophylaxis in humans is, however, not proved1 and recent international guidelines recommend 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.2


NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available recommendations are based on the guideline development group’s opinion of what constitutes good practice. With a serious rare condition, such as infective endocarditis, research using experimental study designs is difficult and the evidence base consists of observational (predominantly case-control) studies. Evidence levels for the recommendations are given in italic in square brackets.

Identifying cardiac risk factors

Regard patients with the following cardiac conditions as being at risk of developing infective endocarditis [based on moderate quality evidence from medium sized observational studies]:

  • Acquired valvular heart disease with stenosis or regurgitation

  • Valve replacement

  • Structural congenital heart disease (including surgically corrected or palliated structural conditions but excluding isolated atrial septal defect, fully repaired …

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