Sir, We read with interest the opinion paper by Thornhill et al.1 about the NICE review of its guideline on prophylaxis against infective endocarditis. We were somewhat surprised that it seems to question the NICE review process and the scientific evidence upon which it is based.
Having reviewed all of the latest evidence, the NICE committee (which included topic experts in cardiology, dentistry and microbiology) has recommended no change to its 2008 guidance. Their findings, set out in a consultation document,2 identify a long-standing increasing incidence of infective endocarditis across the world, not just in the UK. A close reading of the NICE consultation document shows their analysis of the recent paper by Dayer et al.,3 which triggered the review. They found that it overestimated the increase in infective endocarditis incidence since 2008, failed to show any causal link to dental treatment and was at high risk of bias.
Whilst we accept that infective endocarditis is a devastating disease with high morbidity and mortality, the NICE review has again concluded that antibiotic prophylaxis for dental treatment to prevent infective endocarditis remains inappropriate.
We hope that when its recommendations are finally published they will be widely disseminated and accepted by all healthcare professionals and the mixed messages which still exist for some patients will be removed.
References
Thornhill M H, Lockhart P B, Prendergast B, Chambers J B and Shanson D . NICE and antibiotic prophylaxis to prevent endocarditis. Br Dent J 2015; 218: 619–621.
National Institue for Health and Clinical Excellence. Prophylaxis against infective endocarditis. May 2015 - Clinical Guideline 64.1 - Draft for consultation.
Dayer M J, Jones S, Prendergast B, Baddour L M, Lockhart P B, and Thornhill M H . Incidence of infective endocarditis in England, 2000-13: a secular trend, interrupted time-series analysis. Lancet 2015; 385: 1219–1228.
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Thompson, W., Palmer, N. Guideline comment: Infective endocarditis. Br Dent J 219, 303 (2015). https://doi.org/10.1038/sj.bdj.2015.761
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DOI: https://doi.org/10.1038/sj.bdj.2015.761