Prophylaxis against infective endocarditis in obstetrics: New NICE guidance: A commentary

Antibiotic prophylaxis is prescribed on labour wards in the UK for numerous risk factors and procedures, including prolonged rupture of membranes, repair of third-degree tears and during caesarean section. Current practice in the substantial majority of UK units is to give antibiotic prophylaxis to women with cardiac lesions to prevent infective endocarditis. NICE has recommended a substantial change in clinical practice based on one paper describing rates of bacteraemia at caesarean section. NICE has suggested that antibiotic prophylaxis is unnecessary because there is a lack of evidence to support its use. Absence of evidence does not equate to absence of effectiveness when the studies required have not been conducted. Indeed, this is the case for a substantial portion of obstetric management. The American Heart Association guidelines have taken a more measured approach and recommended that women with high-risk cardiac conditions receive prophylaxis, as opposed to a blanket policy of no prophylaxis. Furthermore, good quality data in this area are urgently needed to allow the current dogma of 'antibiotics for all' to be challenged. The International Collaboration on Endocarditis was established in 2002 to facilitate this and to allow a global perspective to be developed. Reporting through a system such as the UK Obstetric Surveillance System would allow reliable UK data to be collected. Risks should continue to be considered on an individual patient basis, and antibiotics prescribed when the clinician and the patient deem this appropriate. © 2008 The Authors.