Infective Endocarditis: Prophylaxis

Key points

• NICE CG64 (2008, amended 2016): antibiotic prophylaxis against infective endocarditis is NOT recommended routinely — the word 'routinely' was added in 2016 to allow individualised clinical judgement and shared decision-making.
• No routine prophylaxis for dental procedures, or for GI, genitourinary (urological, gynaecological, obstetric procedures and childbirth) or respiratory tract (ENT, bronchoscopy) procedures.
• For a very small number of high-risk patients (prosthetic valve, previous infective endocarditis, some congenital heart disease), prophylaxis may be considered in consultation with cardiology (see SDCEP implementation advice).
• Do NOT offer chlorhexidine mouthwash as prophylaxis. Investigate and treat infection promptly in at-risk people; if an at-risk patient has a GI/GU procedure at a site of suspected infection, give an antibiotic that also covers endocarditis organisms.
• Good oral hygiene and regular dental review matter as much as antibiotics. NICE remains more conservative than ESC/AHA, which still advocate prophylaxis for defined high-risk groups undergoing invasive dental procedures.

Decision points in this pathway

• Is the procedure dental, upper/lower gastrointestinal, genitourinary (urological, gynaecological, obstetric, childbirth) or upper/lower respiratory tract (ENT, bronchoscopy)?

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