Angela Sinadinos, Tashin Anwar, Rana El-Nashar, Johnny Reid


Until 2016, The National Institute for Health and Care Excellence (NICE), guidance stated that ‘antibiotic prophylaxis against infective endocarditis (IE) is not recommended’ for high-risk patients undergoing dental procedures. Following an upward trend in cases of IE, NICE reviewed and amended their guidance to state ‘Antibiotic prophylaxis against IE is not recommended routinely’. This puts the onus on healthcare professionals to assess patients individually as to whether or not antibiotic prophylaxis is indicated prior to an invasive dental procedure.


To assess the compliance of the Oral and Maxillofacial department at Pinderfields Hospital with the NICE guidance, more specifically;

  • Do we correctly identify those at high risk of IE?
  • Do we counsel all patients at high risk on the benefits/ risks of antibiotic cover?
  • Do we prescribe high-risk patients cover?

We conducted a prospective audit of all patients attending our outpatient treatment clinic over a 3-month period. We identified high-risk patients for IE and documented their management. We set our standard as 100% compliance with NICE guidance.


Of 287 outpatients seen, 4 patients were identified as high-risk. 75% of these were counselled in line with NICE guidance. All 4 high-risk patients were given antibiotic prophylaxis. The audit also highlighted 2 patients incorrectly identified as high risk.


As a department we need to have clearer guidance on what constitutes a high-risk patient to ensure they are correctly identified. All high-risk patients should be counselled on their risk so that they can make an informed decision as to whether or not they want antibiotic prophylaxis. Following this audit we have introduced a departmental protocol and are piloting an information leaflet for patients. A second cycle in 2018 will assess the effects of these changes.


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     British Association of Oral & Maxillofacial Surgeons
     Royal College of Surgeons of England
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