The Pharmaceutical Journal
476 The Pharmaceutical Journal (Vol 280) 19 April 2008 The latest guideline produced by the National Institute for Health and Clinical Excellence (the second “short” guideline) has been developed to offer best practice advice to the NHS in England, Wales and Northern Ireland on antimicrobial prophylaxis against infective endocarditis (IE) before an interventional procedure. It caters for adults and children in primary dental care, primary medical care, secondary care and care in community settings. In contrast to other recently published national and international guidelines, the NICE guideline explicitly considers the likely cost effectiveness as well as the clinical effectiveness of antibiotic prophylaxis. As a result, the guidance represents a major shift from current accepted practice and therefore it is essential that both appropriate and consistent information is provided to healthcare professionals and patients alike. The following commentary explains some of the rationale for these decisions and highlights the key recommendations.