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Commentary: Controversies in NICE guidance on infective endocarditis

BMJ 2008; 336 doi: (Published 03 April 2008) Cite this as: BMJ 2008;336:771
  1. Mark Connaughton, consultant cardiologist1
  1. 1St Mary’s Hospital, Newport, Isle of Wight PO30 5TG
  1. mconnaughton{at}

Infective endocarditis has always fascinated clinicians, but until 2006 it had rarely caused fisticuffs. In that year, the British Society for Antimicrobial Chemotherapy produced guidelines on the prevention of endocarditis,1 which incensed the British Cardiac Society, apparently causing “dismay among cardiologists and confusion among patients and dentists.”2 The major change was the recommendation to restrict antibiotic prophylaxis to patients judged to be at highest risk. The British Cardiac Society countered by arranging for the National Institute for Health and Clinical Excellence (NICE) to review matters. As a result, NICE has published its own guidelines. Ironically, the draft version received scathing criticism via the British Cardiac Society’s …

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