Rise in endocarditis follows changes to antibiotic guidance
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- Published: Tuesday, 02 December 2014 07:48
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Research led by Prof Martin Thornhill of University of Sheffield shows some increase in cases of infective endocarditis and a reduction in prescriptions for antibiotics following NICE guidance to dentists that prophylaxis should not be given before invasive dental procedures in patients at risk.
NICE said it would immediately review its guidance on the basis of the study but until that was done the existing advice should be followed. Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: "Where new evidence has called into question the safety of current guidance, it is right that we review that guidance as quickly as possible."
Lead author Dr Bernard Prendergast, a cardiologist at Oxford University Hospitals NHS Trust, said it had been important to investigate the impact of the NICE guidance but they could not prove a causal relationship and other explanations such as a change in the bacteria, or patient population were possible. "What is really needed is a randomised controlled trial to address the problem definitively but you would have to do a very large study which would be very expensive and very challenging."
The research was published in The Lancet, which reported that antibiotic prophylaxis given before invasive dental procedures in patients at risk of developing infective endocarditis had historically been the focus of infective endocarditis prevention. Guidelines from the National Institute for Health and Clinical Excellence (NICE) recommended complete cessation of antibiotic prophylaxis for prevention of infective endocarditis in March, 2008. The aim of the research was to investigate changes in the prescribing of antibiotic prophylaxis and the incidence of infective endocarditis since The Lancet report said that researchers had found that prescriptions of antibiotic prophylaxis for the prevention of infective endocarditis fell substantially after introduction of the NICE guidance (mean 10,900 prescriptions per month [Jan 1, 2004, to March 31, 2008] vs 2,236 prescriptions per month [April 1, 2008, to March 31, 2013], p<0·0001).
Starting in March, 2008, the number of cases of infective endocarditis increased significantly above the projected historical trend, by 0·11 cases per 10 million people per month (95% CI 0·05—0·16, p<0·0001). By March, 2013, 35 more cases per month were reported than would have been expected had the previous trend continued. This increase in the incidence of infective endocarditis was significant for both individuals at high risk of infective endocarditis and those at lower risk.
The researchers’ interpretation of these results was: ‘Although our data do not establish a causal association, prescriptions of antibiotic prophylaxis have fallen substantially and the incidence of infective endocarditis has increased significantly in England since introduction of the 2008 NICE guidelines.’
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