New infective endocarditis information card available

A new infective endocarditis information card is available to help healthcare professionals meet the latest guidance for this condition.

It has been produced following the recent change to National Institute of Health and Care Excellence (NICE) guidance, which recognises that antibiotic prophylaxis may sometimes be indicated in high-risk patients having invasive dental procedures.¹ In addition, as a result of the Montgomery case,² new Scottish guidance³ on implementing the NICE document stresses the need for the patient to discuss with their cardiologist or surgeon whether or not antibiotic prophylaxis is indicated and to record the decision.

The card allows this discussion to be recorded. It also gives guidance on what cardiac conditions are regarded as moderate or high-risk for endocarditis, what dental procedures are high-risk and what antibiotics should be prescribed. This card has been endorsed by both the British Heart Valve Society and the British Cardiovascular Society.

Improving outcomes also involves recognising endocarditis early. Since most GPs will never see a case and since the early signs of endocarditis may be indistinguishable from self-limiting viral illnesses, it is appropriate for an informed patient to make the suggestion. Furthermore, one half of cases of culture negative endocarditis occur as a result of antibiotic treatment. This card therefore includes a prompt on when to suspect endocarditis and suggests that a GP considers taking blood cultures before starting antibiotics if endocarditis is possible.

• Copies of the card can be obtained by emailing: [email protected]

References

1. National Institute for Health and Care Excellence. Prophylaxis against infective endocarditis: antimicrobial prophylaxis against infective endoacrditis in adults and children undergoing interventional procedures. Clinical guideline 64. London: NICE, July 2016. https://www.nice.org.uk/guidance/cg64 (accessed 13 March 2019)

2. Southerland L. Montgomery in the Supreme Court: a new legal test for consent to medical treatment. 2015. http://www.scottishlegal.com/2015/03/12/montgomery-in-the-supreme-court-a-new-legal-test-for-consent-to-medical-treatment/ (accessed 13 March 2019)

3. Scottish Dental Clinical Effectiveness Programme: antibiotic prophylaxis against infective endocarditis August 2018. http://www.sdcep.org.uk/published-guidance/antibiotic-prophylaxis (accessed 13 March 2019)