NICE refuses to change dental guidelines on preventing a serious heart infection

September 18, 2015, University of Sheffield
NICE refuses to change dental guidelines on preventing a serious heart infection

The National Institute for Health and Care Excellence (NICE) has today (16 September 2015) announced it will not change its guidelines advising dentists against giving antibiotics before invasive treatment to patients at risk of developing the life-threatening heart disease infective endocarditis (IE).

NICE refused to alter current guidelines, despite research showing a rise in the number of people diagnosed with the condition since the introduction of this guideline, alongside a large fall in the prescribing of (AP) to dental patients.

This decision comes just two weeks after the European Society of Cardiology (ESC) guideline committee announced that after evaluation of the same evidence as reviewed by NICE, it had drawn the conclusion that "the balance of evidence/opinion was in favour of the usefulness/efficacy of antibiotic prophylaxis for those at high-risk of IE" and "it therefore continues to recommend that dentists should give antibiotic prophylaxis to patients at high-risk of IE because it considers the risks of IE outweigh any risks from giving antibiotic prophylaxis".

The pioneering study, which identified the increase in cases of IE in England, is the largest and most comprehensive study into the impact of the current NICE guidelines, which were introduced in March 2008 despite the lack of any new scientific evidence to suggest they were beneficial.

A team of international researchers, led by Professor Martin Thornhill from the University of Sheffield's School of Clinical Dentistry, discovered that since March 2008 there has been an increase in IE cases above the expected trend and by March 2013 this accounted for an extra 35 cases per month in England.

They also identified that the prescribing of antibiotic prophylaxis fell by 89 per cent from 10,900 prescriptions a month, before the 2008 guidelines, to 1,235 a month by March 2013. In a further study published in the Journal of Antimicrobial Chemotherapy in March this year, they also showed that for the majority of patients, antibiotic prophylaxis is a lot safer than was previously thought.

Martin Thornhill, Professor of Translational Research in Dentistry at the University of Sheffield, said: "The decision by NICE to dismiss evidence that their decision in 2008 to recommend cessation of antibiotic prophylaxis could be wrong, as well as evidence that antibiotic prophylaxis is safer than previously thought, will cause understandable disbelief and confusion on the part of many cardiologists, dentists and patients in the UK.

"This is particularly the case, when only two weeks ago, following a review of the same information, the European guidelines committee advised dentists that they should give antibiotic prophylaxis to patients at high-risk of because in their view the risk of not giving antibiotic prophylaxis to these patients far outweighed any risk of giving it."

The studies were carried out by an international team of experts from the University of Sheffield, Oxford University Hospitals NHS Trust, Guy's and St Thomas' NHS Trust, Taunton and Somerset NHS Trust, and the University of Surrey in the UK, as well as from the Mayo Clinic and the Carolinas HealthCare System's Carolinas Medical Centre in the US.

These studies were funded by a grant from national charity Heart Research UK, health plan provider Simplyhealth and the National Institute for Dental and Craniofacial Research (NIDCR).

Heart Research UK National Director, Barbara Harpham, said: "We are baffled as to why NICE has not fully taken account of this new information from Professor Thornhill's research and changed its advice to dentists.

"His evidence shows clearly there has been a marked increase in cases of IE since the advice was given to stop giving antibiotics and this should have at least prompted further investigation by NICE. It seems ludicrous that the UK now stands out on a limb against advice routinely given to dentists in the USA and the rest of Europe to use this preventative treatment that could further protect at-risk patients."

Romana Abdin, Simplyhealth Chief Executive, said: "We need to take a more preventative approach to IE rather than focusing on curing the condition at a more serious stage. Offering an antibiotic to at risk is far less distressing than the prospect of being hospitalised for treatment following diagnosis.

"The research also shows it is more cost effective to administer an antibiotic than to perform surgery which, at a time when NHS resources are stretched, is in itself a reason to update the guidelines. We are committed to supporting evidence based research that supports a healthy nation."

Explore further: Scientists identify a rise in life-threatening heart infection

More information: To view the full NICE guidelines please visit:

Related Stories

Scientists identify a rise in life-threatening heart infection

November 18, 2014
Scientists at the University of Sheffield have identified a significant rise in the number of people diagnosed with a serious heart infection alongside a large fall in the prescribing of antibiotic prophylaxis to dental patients.

ESC infective endocarditis guidelines boost role of imaging in diagnosis

August 29, 2015
ESC Guidelines published today on infective endocarditis boost the role of imaging in diagnosis of this deadly disease.

Antibiotics before heart surgery protect against infection

December 23, 2013
A new study found preoperative antibiotic therapy administered within two hours of cardiac surgery decreased the risk of developing surgical site infections (SSIs) significantly. The study was published in the January issue ...

Patients at risk for blood clots are not receiving recommended treatment

August 10, 2015
Venous thromboembolism (VTE), encompassing deep-vein thrombosis (DVT), or blood clots in leg veins, and pulmonary embolism (PE), or clots that travel to the lungs, is the most common cause of preventable death in hospital ...

Experimental post-exposure antiviral treatment may protect humans from Ebola virus

August 26, 2015
For the first time, UK physicians have demonstrated that antiviral-based therapies have the potential to protect humans from the deadly Ebola virus. The report, published in The Lancet Infectious Diseases journal, describes ...

Drugs used to tackle hospital-acquired infections can increase post-op complications

October 31, 2011
The introduction of new antibiotic regimes to tackle hospital-acquired infections, such as C. difficile, must take into account the possibility of increased infections following specific surgical procedures. That is the key ...

Recommended for you

Sick air travelers mostly likely to infect next row: study

March 19, 2018
People who fly on airplanes while contagious can indeed get other people sick, but the risk is mainly to those seated next to them or in the adjacent row, US researchers said Monday.

Study of COPD patients has created a 'looking glass' into genome of pathogen

March 19, 2018
Decades of work on chronic obstructive pulmonary disease (COPD) at the University at Buffalo and the Veterans Affairs Western New York Healthcare System have yielded extraordinary information about the pathogen that does ...

Newly described human antibody prevents malaria in mice

March 19, 2018
Scientists have discovered a human antibody that protected mice from infection with the deadliest malaria parasite, Plasmodium falciparum. The research findings provide the basis for future testing in humans to determine ...

A multimodal intervention to reduce one of the most common healthcare-acquired infections

March 16, 2018
Surgical site infections are the most frequent health care-associated infections in developing countries. According to the World Health Organization (WHO), this type of infection can affect up to one-third of surgical patients ...

After infection, herpes lurks in nerve cells, ready to strike—New research reveals what enables the virus to do so

March 15, 2018
Once herpes simplex infects a person, the virus goes into hiding inside nerve cells, hibernating there for life, periodically waking up from its sleep to reignite infection, causing cold sores or genital lesions to recur.

New imaging approach offers unprecedented views of staph infection

March 14, 2018
Eric Skaar, PhD, MPH, marvels at the images on his computer screen—3-D molecular-level views of infection in a mouse. "I'm pretty convinced that these are the most advanced images in infection biology," said Skaar, Ernest ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.