Rheumatic Fever IE Prophylaxis — ORE Part 1 MCQ

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ModerateHuman Disease & Dental ManagementRheumatic Fever IE ProphylaxisORE Part 1

A patient with a history of rheumatic fever in childhood asks whether they need antibiotic prophylaxis before dental treatment. They have no current cardiac symptoms, and echocardiography is normal. What is the correct advice according to current UK guidance?

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Correct answer: E — Antibiotic prophylaxis is not indicated as there is no current structural heart disease

Explanation lettering: D = shown as A · E = shown as B · B = shown as D · A = shown as E

A is correct. The patient's normal echocardiography and absence of current cardiac disease mean there is no structural lesion predisposing to infective endocarditis. UK NICE guidance (2008, reaffirmed 2024) and SDCEP implementation advice (endorsed by UK Chief Dental Officers) recommend against routine antibiotic prophylaxis for patients without high-risk cardiac conditions. Prophylaxis is reserved for high-risk patients (valvular disease, prosthetic valves, prior endocarditis, complex cyanotic disease) undergoing 'at-risk' procedures such as extraction or oral surgery. History of childhood rheumatic fever alone, without structural sequelae, does not mandate lifelong prophylaxis. Patients should be counselled about signs/symptoms of IE and good oral hygiene, but routine prophylaxis is not indicated.

Reference: NICE Clinical Guideline 64: Prophylaxis against infective endocarditis (amended 2008, surveillance review 2024). https://www.nice.org.uk/guidance/cg64/ and SDCEP Antibiotic Prophylaxis Against Infective Endocarditis: Implementation Advice (2nd edition, endorsed UK Chief Dental Officers). https://www.antibioticprophylaxis.sdcep.org.uk/