Sir, as you are aware in 2016, the National Institute for Health and Care Excellence (NICE) released guidance that 'antibiotic prophylaxis against infective endocarditis (IE) is not recommended routinely for people undergoing dental procedures'.1
The subjective term 'routinely' is open to interpretation and has caused uncertainty amongst healthcare professionals.
Following this, in August 2018, the Scottish Dental Clinical Effectiveness Programme (SDCEP) published guidance 64 to provide clarification for the management of patients at increased risk of IE.2
It has separated high risk patients into two groups:
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1.
Patients considered to be at high risk of IE
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2.
Patients considered to be at high risk of IE and of potentially severe and life-threatening complications.
Although this guidance aimed to provide clarity, we felt it was still open to interpretation.
At Mid-Yorkshire Hospitals NHS Trust, a consensus protocol was jointly developed by Oral and Maxillofacial Surgery and Cardiology, providing an easy to use algorithm for management of these patients - https://www.midyorks.nhs.uk/oral-and-maxillofacial-surgery .
This protocol has simplified the management of patients at increased risk of IE undergoing invasive oral procedures.
In turn this has streamlined the process and reduced delays to treatment, as communication with cardiology regarding each individual case is not necessary.
We also hope it will prevent over-prescription of antibiotic prophylaxis and this is something we will audit in due course.
We appreciate there may be some difference in opinions amongst cardiologists, however, we would encourage all departments and dental practices to consult with their local cardiology departments to develop a similar protocol.
References
National Institute for Health and Care Excellence. Prophylaxis against infective endocarditis: antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures. Updated in July 2016 Available at https://www.nice.org.uk/guidance/cg64 (accessed March 2019).
Scottish Dental Clinical Effectiveness Programme (SDCEP). NHS Education for Scotland. Antibiotic Prophylaxis Against Infective Endocarditis: Implementation Advice. 2018. Available at http://www.sdcep.org.uk/wp-content/uploads/2018/08/SDCEP-Antibiotic-Prophylaxis-Implementation-Advice.pdf (accessed March 2019).
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El-Nashar, R. Infective endocarditis guidance. Br Dent J 226, 471–472 (2019). https://doi.org/10.1038/s41415-019-0216-8
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DOI: https://doi.org/10.1038/s41415-019-0216-8