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NICE guideline on antibiotic prophylaxis against infective endocarditis

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maiyen on Jun 13, 2009 Says :

cardiology departement

maiyen on Jun 13, 2009 Says :

cardiology departerment

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Notes

Show Notes

Slide 1 :

Prophylaxis against infective endocarditis: antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures Nice Guidance 64 April 2008

Slide 2 :

What this presentation covers Background Recommendations Costs and savings

Slide 3 :

Background Infective endocarditis is an infection of the endocardium. It is a rare condition, but people with certain structural cardiac conditions are at risk. It remains a life-threatening disease with significant mortality (about 20%) and morbidity.

Slide 4 :

Rationale for Antibiotic Prophylaxis Standard practise for 50 years 10 per 100,000 per annum IE life threatening IE follows bacteraemia Dental procedures cause bacteraemias Cases of IE following dental procedures IE usually caused by oral organisms These organisms sensitive to antibiotics

Slide 5 :

Current Status BSAC Guideline 1993 BCS Guideline 2004 ESC Guideline 2004 BSAC Guideline 2006 CDO England letter 2006 AHA Guideline 2007 NICE (Short Guideline) 2008

Slide 6 :

Scope of NICE Guideline To provide evidence-based recommendations to guide healthcare professionals in the appropriate care of people considered to be at increased risk of infective endocarditis who may require antimicrobial prophylaxis before an interventional procedure.

Slide 7 :

Patients at Risk of IE The following patients should be regarded as being at risk of developing infective endocarditis: • acquired valvular heart disease with stenosis or regurgitation • valve replacement • structural congenital heart disease, including surgically corrected or palliated structural conditions but excluding isolated atrial septal defect, fully repaired ventricular septal defect or fully repaired patent ductus arteriosus, and closure devices that are judged to be endothelialised previous endocarditis • hypertrophic cardiomyopathy.

Slide 8 :

Prophylaxis against IE Antibiotic prophylaxis against IE is not recommended: For people undergoing dental procedures For people undergoing non-dental procedures

Slide 9 :

Non Dental Procedures – upper and lower gastrointestinal tract – genitourinary tract; this includes urological, gynaecological and obstetric procedures, and childbirth – upper and lower respiratory tract; this includes ear, nose and throat procedures and bronchoscopy.

Slide 10 :

Rationale Antibiotic prophylaxis against IE is not recommended for patients at risk of IE undergoing dental procedures. No consistent association between having an interventional procedure and the development of IE Regular toothbrushing almost certainly presents a greater risk of IE than a single dental procedure The clinical effectiveness of antibiotic prophylaxis is not proved Antibiotic prophylaxis against IE for dental procedures is not cost effective and may lead to a net loss of life

Slide 11 :

Other recommendations Chlorhexidine mouthwash should not be offered as prophylaxis against IE to people at risk of IE undergoing dental procedures

Slide 12 :

Patient Advice Healthcare professionals should offer people clear and consistent advice about prevention including: Benefits and risks of antibiotic prophylaxis The importance of maintaining good oral health Symptoms that may indicate IE and when to seek expert advice Risks of undergoing invasive procedures such as body piercing or tattooing

Slide 13 :

Managing infection Offer an antibiotic that covers organisms that cause infective endocarditis if a person at risk of infective endocarditis is receiving antimicrobial therapy because they are undergoing a gastrointestinal or genitourinary procedure at a site where there is a suspected infection. Investigate and treat promptly any episodes of infection in people at risk of infective endocarditis to reduce the risk of endocarditis developing.

Slide 14 :

Savings per 100,000 population

Slide 15 :

BCS President's statement on NICE Guideline to prophylaxis against infective endocarditis29 April 2008 British Cardiovascular SocietyAntibiotic Prophylaxis against Infective EndocarditisPosition Statement The National Institute for Health and Clinical Excellence (NICE) published new guidance on the use of antibiotic prophylaxis against infective endocarditis last month . This recommends an end to the long-established practice of prescribing antibiotics for “at risk patients” undergoing routine dental, upper and lower GI tract, genito-urinary tract and respiratory tract procedures. The Society recognises that many of its members may question this approach; indeed 70% of those who participated in a debate at last year’s conference were opposed to the adoption of similar recommendations proposed by the American Heart Association. The BCS contributed to the development of the NICE guidelines in its capacity as a registered stakeholder and has hosted discussions on the guidance at meetings of its Executive, Board and Council. In all these deliberations there has been broad agreement on a number of points:- The available evidence is not conclusive or definitive. The evidence that we do have suggests that, on first principles, antibiotic prophylaxis is likely to be ineffective. It would be very unfortunate if credible authorities produce contradictory guidelines. (The new NICE guidance is broadly in agreement with current American Guidelines, forthcoming ESC guidelines, and the existing British Society for Antimicrobial Therapy guidelines). It is essential to monitor the impact of any change in practice by monitoring the incidence of infective endocarditis closely. In the light of all this the Officers of the BCS have concluded that we should endorse the new NICE guidance whilst recognising that it may create difficulties for some cardiologists and patients. We anticipate that most practising cardiologists will no longer recommend antibiotic prophylaxis to new patients but will not necessarily advise existing patients, some of whom have had the need for antibiotic cover drummed into them over many years, to abandon the practice instantly. Nevertheless, practitioners may wish to explain the change in thinking to existing patients before agreeing how to proceed. We certainly hope that none of our members will feel under undue pressure to change their practice and that patients who wish to continue with antibiotic prophylaxis will be allowed to do so. Indeed, in the absence of definitive evidence, the Society views this issue as “a matter of conscience” and will support any member who chooses to recommend antibiotic prophylaxis in selected circumstances. Dr Nicholas BoonPresidentOn behalf of the BCS Executive and Guidelines and Practice Committee

Slide 16 :

Visit www.nice.org.uk/cg64

Slide 17 :

	d.wray@dental.gla.ac.uk 1 Years ago. Category: Cardiology

Tags:	Cardiology

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