Prophylactic antibiotic coverage in patients with total arthroplasty: current practice

The need for prophylactic antibiotic coverage before dental treatment to prevent late prosthetic joint infection has not been established. Most orthopedic surgeons who responded to the survey thought that no relationship existed between dentally induced transient bacteremias and prosthetic joint infections, but a majority of these respondents recommended antibiotic prophylaxis anyway. The current literature discloses few late prosthetic joint infections that can be attributed to the transient bacteremia expected to occur after dental treatment. Most of the respondents who recommended prophylactic antibiotics, preferred a cephalosporin. The use of this antibiotic may not be indicated because transient bacteremias that occur after dental treatment primarily are streptococcal and are of oral origin. The preferred drug for the control of oral organisms remains penicillin. Penicillin also remains the antibiotic recommended by the American Heart Association as the preferred prophylaxis against infective endocarditis secondary to dental treatment. Before any definitive statement concerning the prevention of prosthetic joint infections occurring after dentally induced transient bacteremias can be made, additional research needs to be conducted to determine the extent of the relationship and to determine the antibiotic most effective in controlling the specific bacteria involved. Currently, we recommend that dental practitioners who provide treatment to patients with arthroplasty consult with and follow the recommendations of the patient's orthopedic surgeon regarding antibiotic prophylaxis. However, we believe that the orthopedic and dental professions need to form a joint committee to examine and evaluate the current data. After this evaluation, a joint statement that concerns the relationship of and recommendations for the prevention of dentally induced bacteremias and joint infections should be issued.