Q. What happens when the patient's cardiologist insists that in spite of NICE guidance, antibiotic cover must still be provided?

Each clinician has his/her own separate duty of care to the patient. An opinion expressed by the patient's cardiologist (or orthopaedic surgeon, or GP) is a valid consideration as part of the overall ‘mix"' of information, but it is not in itself definitive. You should certainly not rely upon a second-hand (‘hearsay') account of what the cardiologist may or may not have said to the patient.

Unquestioningly following an opinion such as this, even if it has been confirmed in writing, when it clearly conflicts with guidelines issued by an authoritative body, is inadvisable and may be difficult to defend. This conflict of opinion is something that needs to be discussed with the clinician concerned, and also with the patient, as part of a proper consent process.

If you do not believe that you should be prescribing antibiotics in the specific circumstances of an individual patient, then you should not do so. Explain your decision to the patient and keep a full contemporaneous (ie. made at the time) record of this conversation in the patient's clinical notes.

You can read our position statement on antibiotic prophylaxis and find other FAQs relating to the NICE guidance here