Sir, the article by Thornhill et al. (A change in the NICE guidelines on antibiotic prophylaxis BDJ 2016; 221: 112–114) raises some fundamental questions about NICE.

While NICE guidelines should always be precisely that – guidelines rather than protocols – and clinicians should exercise clinical judgement in the context of an informed discussion with patients and their close ones where appropriate (what is new?), the purpose of NICE is surely to provide unambiguous, evidence-based recommendations. Patients should have a reasonable expectation that they are managed in a way that is consistent across the profession. Whatever one's position might be in the 'cover', 'no cover', or 'cover sometimes' debate (which still remains largely opinion based), at least the 2008 iteration of CG64 achieved clarity and unambiguity (it also directed attention to what in my mind is the most important issue in all of this – namely high standards of oral hygiene and rapid management of sepsis). The July 2016 iteration does anything but; in fact it dangerously re-focusses the debate on prophylaxis rather than on those crucial preventive factors and leaves the clinician wondering 'who is right?' We do not even have a current UK antibiotic prophylaxis regime should we decide to cover (although Thornhill et al. provide guidance in their article). To add insult to injury, if not for the opinion piece in this Journal, most practitioners would probably not even be aware of this important development. This really is not good enough.

Thornhill et al. are to be congratulated for their thoughtful and thought-provoking piece; NICE should look to its laurels.

1. Liverpool