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Fig. 5 | BMC Medicine

Fig. 5

From: Investigation of the impact of the NICE guidelines regarding antibiotic prophylaxis during invasive dental procedures on the incidence of infective endocarditis in England: an electronic health records study

Fig. 5

Temporal association of guideline change and incidence of infective endocarditis. a Annual prescriptions of 3 g amoxicillin dispensed in the community. Grey bar represents year of guideline change. b Hypothesised trend change in cases of infective endocarditis and in proportion of infective endocarditis cases linked to oral streptococci, assuming that dental antibiotic prophylaxis is protective of infective endocarditis (based on an assumed background of linearly increasing cases unrelated to oral prophylaxis). The solid line demonstrates an immediate effect, the dotted line demonstrates a delayed effect (assuming an incubation period of around 6 months—longer incubation periods would extend the delay in effect, and shorter incubation periods would move it closer to the solid line). c Actual trend change in cases of infective endocarditis after applying a non-parametric LOWESS smoother. d Actual trend change in proportion of infective endocarditis cases matched to a streptococcal organism code (including mixtures), after applying a non-parametric LOWESS smoother. Dotted vertical lines represent date of guideline change

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