Antibiotic prophylaxis in dentistry: part I. A qualitative study of professionals' views on the NICE guideline

The NICE guideline for antibiotic prophylaxis before dental treatment has made a substantive change and fundamental departure from previous practice that affects long-standing beliefs and practice patterns. There is potential difficulty for healthcare professionals explaining the new guidance to patients who have long believed that they must receive antibiotics before their dental treatment.

To explore clinicians' attitudes towards the NICE guidance on antibiotic prophylaxis, their use of the guideline in clinical practice, barriers to the implementation of the guideline, and how best to overcome any perceived barriers.

In-depth interviews were conducted with seven dental care professionals, two cardiologists and a cardiac care nurse. The data were analysed using the framework method to extract central themes and opinions.

Clinicians generally perceived that initially patients would be reluctant to follow the NICE guidance. This was felt to be particularly true of the patient cohort that had previously been prescribed prophylactic antibiotics. They found it difficult to explain the new guidance to patients who have had infective endocarditis and have long believed that they must receive antibiotics before their dental treatment. Concerns were also raised about the legal position of a clinician who did not follow the guidance. Clinicians generally suggested that the provision of accurate information in the form of leaflets and valid websites would be the best way to advise patients about the new guidance.

Clinicians anticipated difficulties in explaining to patients the change in clinical practice necessitated by adherence to the NICE guidance, most notably for patients with a history of infective endocarditis or where the patient's cardiologist did not agree with the NICE guidance. They placed particular emphasis on the provision of accurate information in order to reassure patients.