Research from the University of Sheffield has found that a common treatment for a life-threatening heart condition has little significant impact on patient outcomes. The paper is due for publication this week (Saturday 21 May) in the British Medical Journal (BMJ).
Led by Martin Thornhill, Professor of Oral Medicine at the University of Sheffield and Honorary Consultant in Oral Medicine at Sheffield Teaching Hospitals NHS Foundation Trust, the research team has assessed the impact of the prescription of antibiotics on the prevention of infective endocarditis – the inflammation of the inner lining of the heart – prior to invasive dental procedures.
Until March 2008, it was common practice in the United Kingdom to prescribe antibiotics before such procedures to help prevent the condition, which affects around 10 in 100,000 people in the UK every year. However, the National Institute for Health and Clinical Excellence (NICE) passed guidance at this time recommending the cessation of the treatment, due to doubts over its effectiveness.
There is considerable debate internationally around the use of the treatment and so the team set about a study to ascertain the impact the guidance has had on the incidence of endocarditis in the UK.
Analysing the rates of prescription of the antibiotics together with the incidence of the condition across the UK for the two years following the introduction of the guideline, the researchers found that whilst prescriptions decreased by 78.6%, there was no significant increase in number of cases of, or deaths caused by, endocarditis. However, as 20% of the patients were still being prescribed antibiotics, the research could not judge the impact of the NICE guidelines on this group.
Professor Martin Thornhill said: “The prescription of antibiotics in the treatment of endocarditis is a very controversial area, but one that has a profound impact on patients.
“In most parts of the world it is still standard procedure to prescribe antibiotics for this condition, and indeed this was the case in the UK until 2008. However, with the introduction of the NICE guideline in 2008 it was important that we analysed the impact of changing practices across the country.
“Our study has shown that there has not been any significant increase in the number of cases of, or deaths caused by, endocarditis, and supports the NICE guideline recommendations in this respect. However, it does not rule out the possibility that antibiotics may be beneficial in certain circumstances and further research is needed to look into these in more detail.”
The team of authors who carried out the research is made up of cross-disciplinary experts from the UK and the United States.