Antibiotic clarification sought
CDO asks working group to consider implications of NICE guideline after concerns raised among Scottish dental profession
The Scottish Dental Clinical Effectiveness Programme (SDCEP) has announced that it is working to clarify advice to dentists around antibiotic prophylaxis to prevent infective endocarditis (IE).
Last year, the National Institute for Health and Care Excellence (NICE) amended its Clinical Guideline 64 Prophylaxis Against Infective Endocarditis.The word ‘routinely’ was added to the recommendation covering provision of antibiotic prophylaxis, to read: “Antibiotic prophylaxis against infective endocarditis is not recommended routinely for people undergoing dental procedures.”
NICE explained that this amendment was made to ensure consistency with other recommendations in the guideline and emphasises the responsibility of healthcare professionals to take account of patients’ values and preferences when offering treatment options.
Antibiotic prophylaxis against infective endocarditis is not recommended routinely for people undergoing dental procedures
However, SDCEP revealed it has been made aware that there is some confusion in the dental community about the implications of the amendment. Following publication of the original NICE guideline in 2008, standard practice has been to not provide antibiotic prophylaxis against IE, even for high risk patients, as there is no evidence it is of any benefit. This has been accompanied by a significant decrease in the number of prescriptions for 3g sachets of amoxicillin in Scotland. There is now concern that there is a risk of variation in practice due to differing interpretations of the amended recommendation.
CDO Margie Taylor has therefore asked the SDCEP to provide advice to help dental practitioners implement the NICE guideline.
Currently, guidance on antibiotic prophylaxis, referencing the 2008 NICE guideline, is included in SDCEP’s Drug Prescribing for Dentistry guidance and Dental Prescribing app. SDCEP has convened a short-life working group to consider the implications of the amendment to the NICE recommendation and advice on this topic will be made available in 2018.
This is likely to be published as an update to the prescribing guidance and provided as a download from the SDCEP website, www.sdcep.org.uk and via SDCEP’s Dental Prescribing app.