The SDCEP implementation advice, which has been formally endorsed by NICE, has been developed to help dental teams manage the care of patients at increased risk of infective endocarditis, a rare but life-threatening infection of the lining of the heart.
NICE Clinical Guideline 64 (CG64), first published in 2008, updated in 2015 and amended in 2016, includes recommendations on preventing infective endocarditis in people who are at increased risk of developing this condition. SDCEP’s advice aims to clarify and facilitate the implementation of the most recent iteration of the recommendations and supports management of the oral health of patients at increased risk of infective endocarditis. The advice emphasises the importance of including the patient in discussions about their care and provides information about identifying the small number of increased risk patients for whom antibiotic prophylaxis may be indicated. Advice for cardiology and cardiac surgical teams is included and an information leaflet for patients is provided to help practitioners explain the NICE recommendation, support discussions with patients and parents or carers and provide reassurance about their care.
The advice was developed to address concerns among dental and cardiology professionals over interpretation and consistency of application of CG64 following the 2016 amendment. It was created via a rapid process that draws on elements of SDCEP’s NICE-accredited guidance development methodology. This SDCEP advice is a departure from conventional clinical guidance in that it supports the implementation of evidence-based recommendations from another organisation rather than independently developed evidence-based clinical recommendations.
The chair of the group that developed the advice, professor Jeremy Bagg, said,
"NICE CG64 states that ‘Antibiotic prophylaxis against infective endocarditis is not recommended routinely for people undergoing dental procedures’. The SDCEP implementation advice aims to clarify which patient groups are considered ‘non-routine’ and for whom prophylaxis may be an option, providing clear and practical advice on how to advise and care for these patients. By following this advice, practitioners can ensure that patients are involved in decisions about their care and can encourage measures to prevent dental disease and therefore the need for invasive dental procedures.
“The advice was developed by a group drawn from across the UK that included experienced healthcare professionals from dentistry, cardiology and pharmacy, members of the NICE CG64 development committee and patient representatives. The practical advice aims to help the dental community implement the NICE recommendations and provide appropriate care for their patients.”
Dr Andrew Wragg, vice president for clinical standards at the British Cardiovascular Society, said, “This new implementation advice from SDCEP, published after widespread consultation, is a pragmatic document that will assist cardiovascular specialists, dentists and their patients in discussions about prophylaxis. The document clarifies which patients may need special consideration for antibiotic prophylaxis and ensures that patients are at the centre of the decision-making process. The British Cardiovascular Society has been actively involved in the development of this document and is very happy to endorse it. We believe it will help patients, in collaboration with their doctors and dentists to make informed judgements about this important clinical management decision.”
David Felix, postgraduate dental dean for Scotland, NHS Education for Scotland (NES), said, “NES welcomes the publication of the implementation advice on Antibiotic Prophylaxis Against Infective Endocarditis as a valuable resource for dental professionals in Scotland and across the rest of the UK. This will encourage a consistent approach to the delivery of dental care for patients at increased risk of infective endocarditis and is another example of how the work of the Scottish Dental Clinical Effectiveness Programme supports the delivery of high quality healthcare that is safe, person-centred and effective."
Further information on the work of SDCEP is available at www.sdcep.org.uk from where the new implementation advice can also be downloaded.