Antibiotic prophylaxis of endocarditis: the rest of the world and NICE

Previous guidelines1,2 recommended antibiotic prophylaxis for the majority of patients with congenital and heart valve disease. Almost all current national or international guidelines, including those from the USA,3,4 Europe5 and Australia,6,7 have narrowed these recommendations radically, but still recommend prophylaxis for certain dental procedures in high-risk cardiac patients (Table 1). NICE8 is alone in recommending no antibiotic prophylaxis for any cardiac patients undergoing dental or non-dental procedures except for manipulations at an infected non-dental site. Most cardiologists and cardiac surgeons still follow international guidelines rather than NICE. Is this justified?