Key result
Antibiotic prophylaxis cessation linked to ~61% higher infective endocarditis admissions in England versus Scotland.
Why the study?
Implementation of the 2008 NICE recommendation to cease antibiotic prophylaxis before invasive dental procedures differed between England and Scotland, especially after 2018 Scottish guidance advised considering prophylaxis for high-risk individuals. The comparative effects of this differing guidance on antibiotic prophylaxis prescribing and infective endocarditis admissions required evaluation.
Does the complete cessation of antibiotic prophylaxis prior to invasive dental procedures increase infective endocarditis hospital admissions compared to policies recommending antibiotic prophylaxis for high-risk individuals?
Observational
Yes
Does the complete cessation of antibiotic prophylaxis prior to invasive dental procedures increase infective endocarditis hospital admissions compared to policies recommending antibiotic prophylaxis for high-risk individuals?
Complete cessation of antibiotic prophylaxis prior to invasive dental procedures in England was associated with a significantly greater increase in infective endocarditis hospital admissions compared to Scotland's policy of considering prophylaxis for high-risk patients.
Answers are grounded in this paper and cite their sources.
Divergent national AP policies coincided with differing IE trends; leaves open whether targeted prophylaxis reduces risk in high-risk patients.
Background Use of antibiotic prophylaxis (AP) prior to invasive dental procedures (IDPs) to prevent infective endocarditis (IE) fell dramatically in the UK when the National Institute for Health and Care Excellence (NICE) recommended its cessation in 2008. However, guidance implementation by dentists, general medical practitioners (GPs) and others differed in England and Scotland, particularly after 2018 when the Scottish Dental Clinical Effectiveness Programme advised Scottish dentists to consider AP for high-risk individuals. We compared the effects of this differing guidance on AP prescribing and IE-admissions. Methods A quasi-experimental (natural) longitudinal-study design was used to compare aggregated national AP prescribing (2002–2025) and IE-admissions data (1998–2025) for England and Scotland. Interrupted time series and difference-in-differences analyses were used to evaluate changes. Findings AP prescribing fell 93% in England after the 2008 NICE guidelines and remained low (2567 [95% CI 2433–2701] prescriptions/million/annum before 2008 vs 185 [95% CI 165–204] prescriptions/million/annum after 2021/2, p < 0.0001), while IE-admissions increased by 112% (26 [95% CI 25–27] admissions/million/annum before 2008 vs 55 [95% CI 54–56]/million/annum after 2021/2, p < 0.0001). In Scotland, AP prescribing fell less, because GP prescribing replaced some dental prescribing, then rose again after 2018 and finished 2.86 times higher than in England (1884 [95% CI 1816–1952] prescriptions/million before 2008 vs 528 [95% CI 350–705] prescriptions/million after 2021/2). Correspondingly, Scottish IE-admissions rose less (24 [95% CI 23–25] admissions/million before 2008 vs 34 [95% CI 32–37] admissions/million after 2021/2, p < 0.0001) than in England, and English IE-admissions/million ended 61% higher than in Scotland (p < 0.0001). Interpretation Although our data do not establish causality, they suggest that cessation of AP may be followed by a significant increase in IE-admissions compared with policies recommending AP for high-risk individuals.
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Thornhill et al. (2026) conducted an observational in Infective endocarditis. Cessation of antibiotic prophylaxis prior to invasive dental procedures (England NICE guidance) vs. Guidance recommending antibiotic prophylaxis consideration for high-risk individuals (Scotland SDCEP guidance) was evaluated on Infective endocarditis hospital admissions per million per annum (post-2021/2) (p=<0.0001). Cessation of antibiotic prophylaxis in England led to a 112% rise in infective endocarditis admissions, ending 61% higher than in Scotland (55 vs 34/million/annum, p<0.0001).
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