Advice on Antibiotic Prophylaxis for Infective Endocarditis
Antibiotic prophylaxis (ABP) is not routinely recommended for dental procedures, according to NICE Clinical Guideline 64 (CG64). Instead, management strategies depend on the patient’s cardiac condition and risk level for infective endocarditis (IE).
Patients at Increased Risk
NICE identifies the following conditions as increasing IE risk:
- Acquired valvular heart disease (stenosis or regurgitation).
- Hypertrophic cardiomyopathy.
- Previous infective endocarditis (IE).
- Structural congenital heart disease, excluding fully repaired conditions with no residual effects.
- Valve replacements.
Special Consideration Subgroup:
Some high-risk patients require non-routine management, including:
- Those with prosthetic valves or materials used in valve repair.
- Patients with a history of IE.
- Congenital heart disease (e.g., cyanotic conditions, repairs with residual defects).
Management Approaches
Routine Management
Most at-risk patients can be treated without ABP. Dentists should:
- Inform patients of their IE risk and provide prevention advice, including the importance of oral hygiene and awareness of symptoms.
- Record discussions in clinical notes.
- Address patient preferences—if ABP is requested, consult their cardiologist.
- Promptly treat dental infections to minimise IE risks.
Non-Routine Management
For high-risk patients in the special consideration subgroup:
- Collaborate with cardiology specialists to assess the need for ABP.
- If ABP is considered, discuss its risks and benefits with the patient to ensure informed consent.
- Offer preventative advice on oral health and risks of invasive procedures like body piercings.
- Document all decisions and patient discussions in their clinical records.
Special Considerations for Children
Children with cardiac conditions require additional care, particularly regarding consent. Practitioners must evaluate whether the child can consent independently (e.g., under Gillick competence) or involve a parent/guardian. Referrals for sedation or general anaesthesia should be made for uncooperative children.