ArticleBMJ (Clinical research ed.)2011
Impact of the NICE guideline recommending cessation of antibiotic prophylaxis for prevention of infective endocarditis: before and after study.
Article in BMJ (Clinical research ed.), 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 80 papers, 6 of them syntheses that pooled it.
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Who cites it
80 citing papers in PubMed, 6 syntheses or guidelines pooled it, 245 citations in OpenAlex.
- Antibiotic prophylaxis before dental procedures to prevent infective endocarditis: a systematic review.Infection · 2023Pooled it
- Antibiotic prophylaxis for preventing bacterial endocarditis following dental procedures.The Cochrane database of systematic reviews · 2022Pooled it
- Pooled it
- Government policy interventions to reduce human antimicrobial use: A systematic review and evidence map.PLoS medicine · 2019Pooled it
- The effect of interventions aiming to optimise the prescription of antibiotics in dental care-A systematic review.PloS one · 2017Pooled it
- Epidemiology of infective endocarditis beforeTherapeutic advances in cardiovascular diseasePooled it
- Antibiotic Prophylaxis of Infective Endocarditis in Dentistry: An Update on the ESC, AHA, and NICE Guidelines.Journal of clinical medicine · 2026Review
- An important change in infective endocarditis prevention guidance.British dental journal · 2026Article
- Article
- Evaluating the impact of 2008 NICE dental prophylaxis guidelines on surgically treated infective endocarditis: a single centre retrospective analysis.Journal of cardiothoracic surgery · 2026Article
- Infective Endocarditis Risk After Invasive Dental Procedures.Mayo Clinic proceedings. Innovations, quality & outcomes · 2025Article
- Similarities in the consumption trajectory of antibacterial drugs in the outpatient care sector in Germany from 1986 to 2022: identification of shared patterns, correlation analysis of prescribed defined daily dose and assessment of underlying influences.Naunyn-Schmiedeberg's archives of pharmacology · 2025Article
- Mapping Review of the Correlations Between Periodontitis, Dental Caries, and Endocarditis.Dentistry journal · 2025Review
- Increase in Oral Streptococcal Endocarditis Among Moderate-Risk Patients: Impact of Guideline Changes on Endocarditis Prevention.JACC. Advances · 2024Article
- Is topical antibiotic use necessary to prevent surgical site infection following oculoplastic surgery?Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2024Article
- Endocarditis prevention: time for a review of NICE guidance.The Lancet regional health. Europe · 2024Review
- Infective Endocarditis among Pediatric Patients with Prosthetic Valves and Cardiac Devices: A Review and Update of Recent Emerging Diagnostic and Management Strategies.Journal of clinical medicine · 2023Review
- A prospective cluster trial to increase antibiotic prescription quality in seven non-ICU wards.GMS hygiene and infection control · 2023Article
- Infective endocarditis following invasive dental procedures: IDEA case-crossover study.Health technology assessment (Winchester, England) · 2022Observational
- Infective endocarditis in paediatric population.European journal of pediatrics · 2021Review
20 more citing papers are in PubMed but not listed here.
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Authors and funding
7 authors at 5 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo quantify the change in prescribing of antibiotic prophylaxis before invasive dental procedures for patients at risk of infective endocarditis, and any concurrent change in the incidence of infective endocarditis, following introduction of a clinical guideline from the National Institute for Health and Clinical Excellence (NICE) in March 2008 recommending the cessation of antibiotic prophylaxis in the United Kingdom.
designBefore and after study.
settingEngland. Population All patients admitted to hospital in England with a primary or secondary discharge diagnosis of acute or subacute infective endocarditis.
main outcome measuresMonthly number of prescriptions for antibiotic prophylaxis consisting of a single 3 g oral dose of amoxicillin or a single 600 mg oral dose of clindamycin, and monthly number of cases of infective endocarditis, infective endocarditis related deaths in hospital, or cases of infective endocarditis with a possible oral origin for streptococci.
resultsAfter the introduction of the NICE guideline there was a highly significant 78.6% reduction (P < 0.001) in prescribing of antibiotic prophylaxis, from a mean 10,277 (SD 1068) prescriptions per month to 2292 (SD 176). Evidence that the general upward trend in cases of infective endocarditis before the guideline was significantly altered after the guideline was lacking (P = 0.61). Using a non-inferiority test, an increase in the number of cases of 9.3% or more could be excluded after the introduction of the guideline. Similarly an increase in infective endocarditis related deaths in hospital of 12.3% or more could also be excluded.
conclusionDespite a 78.6% reduction in prescribing of antibiotic prophylaxis after the introduction of the NICE guideline, this study excluded any large increase in the incidence of cases of or deaths from infective endocarditis in the two years after the guideline. Although this lends support to the guideline, ongoing data monitoring is needed to confirm this, and further clinical trials should determine if antibiotic prophylaxis still has a role in protecting some patients at particularly high risk.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.