Abstract | OBJECTIVE: DESIGN: Before and after study. SETTING: England. Population All patients admitted to hospital in England with a primary or secondary discharge diagnosis of acute or subacute infective endocarditis. MAIN OUTCOME MEASURES: RESULTS: After the introduction of the NICE guideline there was a highly significant 78.6% reduction (P < 0.001) in prescribing of antibiotic prophylaxis, from a mean 10,277 (SD 1068) prescriptions per month to 2292 (SD 176). Evidence that the general upward trend in cases of infective endocarditis before the guideline was significantly altered after the guideline was lacking (P = 0.61). Using a non-inferiority test, an increase in the number of cases of 9.3% or more could be excluded after the introduction of the guideline. Similarly an increase in infective endocarditis related deaths in hospital of 12.3% or more could also be excluded. CONCLUSION: Despite a 78.6% reduction in prescribing of antibiotic prophylaxis after the introduction of the NICE guideline, this study excluded any large increase in the incidence of cases of or deaths from infective endocarditis in the two years after the guideline. Although this lends support to the guideline, ongoing data monitoring is needed to confirm this, and further clinical trials should determine if antibiotic prophylaxis still has a role in protecting some patients at particularly high risk.
|
Authors | Martin H Thornhill, Mark J Dayer, Jamie M Forde, G Ralph Corey, Vivian H Chu, David J Couper, Peter B Lockhart |
Journal | BMJ (Clinical research ed.)
(BMJ)
Vol. 342
Pg. d2392
(May 03 2011)
ISSN: 1756-1833 [Electronic] England |
PMID | 21540258
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
|
Chemical References |
- Anti-Bacterial Agents
- Clindamycin
- Amoxicillin
|
Topics |
- Acute Disease
- Administration, Oral
- Amoxicillin
(administration & dosage)
- Anti-Bacterial Agents
(administration & dosage)
- Antibiotic Prophylaxis
- Clindamycin
(administration & dosage)
- Endocarditis
(prevention & control)
- Hospitalization
- Humans
- Practice Guidelines as Topic
|