National Institute for Health and Clinical Excellence (NICE)
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NICE publishes draft updated guidance on the use of antibiotics to prevent infective endocarditis

NICE has today announced that its original guidance on the use of antibiotics to prevent infective endocarditis will remain unchanged following a review of evidence published since the original 2008 guidance.

NICE’s draft update of its guidance published today for consultation continues to recommend that antibiotics to prevent infective endocarditis should not be given to adults and children with structural cardiac defects at risk of infective endocarditis who are undergoing dental and non-dental interventional procedures (upper and lower respiratory tract procedures, upper and lower gastrointestinal tract procedures, genitourinary tract procedures).

With an annual incidence of fewer than 10 per 100,000 cases, infective endocarditis is a rare but potentially fatal infection of the endocardium (heart lining), particularly the heart valves.

The 2008 recommendations were reviewed by a NICE standing committee responsible for updating clinical guidelines after researchi published at the end of last year suggested that the number of people developing the potentially fatal condition has increased following NICE’s original guidance.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said:“We’ve looked in detail at data published since our original guideline in 2008. This shows that the incidence of IE continues to increase across the world - a trend that has been apparent even before the 2008 NICE guideline. There could be a number of possible reasons for this – for example aging populations with multi-morbidity, or an increase in the number of people having hemodialysis for kidney failure. However, what does seem to be clear is that there is no link between the rise in cases and publication of the NICE guidance in 2008 recommending that people at risk of infective endocarditis should not be prescribed prophylactic antibiotics.

“In recommending no change to our original guidance we have also been mindful about what is the balance between any potential benefits in increasing antibiotic prophylaxis and potential risks of increasing anaphylaxis and antibiotic resistance.

“Importantly, we have also recommended further research into what other factors could be accounting for the rise in the number of people being diagnosed with infective endocarditis.

“We now look forward to hearing the views of stakeholders on this draft guidance to help inform the final guidance which is due to be published in August.”  

For more information call the NICE press office on 0300 323 0142 or out of hours on 07775 583 813.

Notes to Editors


      i. Dayer MJ et al. Incidence of infective endocarditis in England, 2000–13: a secular trend, interrupted time-series (ITS) analysis. Lancet

About the draft guidance on prophylaxis against infective endocarditis

  1. The draft guidance on prophylaxis against infective endocarditis is available at The consultation on the draft guideline will be open until 29 June. 

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