Endocarditis

This is a summary of the NICE guidelines

The guideline indicates that routine prophylaxis is not indicated for certain defined interventions. It does not indicate when prophylaxis should be used - presumably this is left to local policy.
No antibiotic or chlorhexidine prophylaxis for dental procedures
No antibiotic prophylaxis for upper and lower GI procedures
No antibiotic prophylaxis for GU procedures: includes urological, gynae, obstetric and childbirth
No antibiotic prophylaxis for respiratory tract procedures: includes ENT and bronchoscopy
But give prophylaxis that covers organisms likely to cause IE when the above procedures are being performed at an infected site
People at risk of infective endocarditis
Acquired valvular disease with stenosis or regurgitation
Valve replacement
Structural congenital heart disease including surgically-corrected, but excluding:
  • isolated ASD
  • fully repaired VSD
  • fully repaired PDA
  • Endothelialized closure devices
Previous infective endocarditis
Hypertrophic cardiomyopathy
Risk of IE per following repair of major congenital heart defects
Risk Defect Risk per 1000 patient-years
* - after surgical correction
High Pulmonary atresia with VSD 11.5
Tetralogy of Fallot with systemic-to-pulmonary shunt 8.2
Aortic valve stenosis* 7.2
Pulmonary atresia* 6.4
Unoperated VSD 3.8
Moderate to low Primum ASD with cleft mitral valve* 1.8
Coarctation of the aorta* 1.2
Complete atrioventricular septal defect* 1.0
Tetralogy of Fallot* 0.7
Dextrotransposition of the great arteries* 0.7
No documented risk VSD* 0
ASD* 0
PDA* 0
Pulmonary stenosis* 0