During a routine clinic follow-up, a patient with an indwelling ventriculo-peritoneal shunt enquires whether prophylactic antibiotics are necessary prior to routine dental hygiene work. He produces a letter from his dentist enquiring the same.

Dr Max Nathan of Morriston Hospital, Swansea, UK has had this happen … has it happened to you? And what did you do?

(I think it raises some interesting questions – how much do we need to worry vs how much do we need to know about ‘something’ before we act? If you already advise to take, what would it take to stop you? If you advise to avoid, how much data would you need to change your mind?)

[Edit – 27 March 2008]

Since first posting,  in February, the BNF committee has produced new guidance highlighting the ineffectiveness of antibacterial prophylaxis for preventing bacterial endocarditis. This accords with the findings of Dr Nathan and colleagues.