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Antibiotic prophylaxis for infective endocarditis — ORE Part 1 MCQ

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HardDental Pharmacology and TherapeuticsAntibiotic prophylaxis for infective endocarditisORE Part 1

A 55-year-old with a previous episode of infective endocarditis requests antibiotic prophylaxis before supragingival scaling. He is well, afebrile and has no active oral infection. The dentist is practising in the UK and applies current NICE guidance, including individual clinical assessment where appropriate. Which statement best explains why routine antibiotic prophylaxis is not recommended?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Evidence has not established that routine prophylaxis provides net clinical benefit

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

**C is correct.** Previous infective endocarditis is an increased-risk cardiac condition, but NICE states that antibiotic prophylaxis is **not recommended routinely** for dental procedures. NICE’s evidence review found that the effectiveness of prophylaxis in preventing infective endocarditis has not been established with sufficient certainty, while prescribing has potential harms, including allergic reactions and antimicrobial-resistance consequences. The appropriate UK approach is therefore not automatic prescribing: assess the procedure and individual circumstances, and use shared decision-making with reference to SDCEP advice. A is false because dental procedures may cause transient bacteraemia. B is false because oral bacterial exposure and oral health remain relevant; NICE specifically emphasises maintaining good oral health. D is false because antibiotics can cause adverse reactions. E is false because cardiac risk does not prohibit routine oral hygiene or periodontal care; good oral health is encouraged.

Reference: National Institute for Health and Care Excellence. Prophylaxis against infective endocarditis (CG64), Recommendations 1.1.1–1.1.3 and 2024 exceptional surveillance evidence review. 2024. https://www.nice.org.uk/guidance/cg64/chapter/recommendations