Infective Endocarditis Prophylaxis — ORE Part 1 MCQ

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ModeratePharmacology & TherapeuticsInfective Endocarditis ProphylaxisORE Part 1

A patient is scheduled for an invasive dental procedure involving manipulation of the gingival tissues. Under NICE CG64 and current SDCEP implementation advice, for which patient should antibiotic prophylaxis be given special consideration following an individual discussion of benefits and harms?

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Correct answer: B — A patient with a previous episode of infective endocarditis

Answer: A. NICE classifies previous infective endocarditis as an increased-risk cardiac condition, and SDCEP places patients with previous IE in the high-risk subgroup for whom antibiotic prophylaxis should receive special consideration before invasive dental procedures. This is an individualised decision after discussing potential benefit and antimicrobial harms; it is not a blanket prescription for every dental procedure. A prosthetic hip joint does not confer IE risk. Mitral valve prolapse without regurgitation is not in the SDCEP high-risk subgroup. An isolated atrial septal defect is specifically excluded from NICE structural congenital heart disease risk criteria. A ventricular septal defect is not sufficient as stated: special consideration applies only to particular high-risk congenital conditions, such as unrepaired cyanotic disease or specified repairs involving prosthetic material or residual defects.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP), Antibiotic Prophylaxis Against Infective Endocarditis, Executive summary, current online implementation advice. https://www.antibioticprophylaxis.sdcep.org.uk/implementation-advice/executive-summary/executive-summary/