Prosthetic hip infection related to a dental procedure despite antibiotic prophylaxis

A 39-year-old man with systemic lupus erythematosus who was taking corticosteroids had a prosthetic hip infection with Streptococcus oralis after a dental procedure despite prophylaxis with erythromycin. The causative organism was resistant to erythromycin. For patients with prosthetic joints the literature does not support dental prophylaxis, which even if given appropriately, may fail to prevent infection. Some experts advocate giving antibiotic prophylaxis to patients at high risk, although data supporting this practice are limited. However, considering that most orthopedic surgeons and many dental clinicians provide antibiotic prophylaxis, alternatives to erythromycin such as a first-generation cephalosporin should be considered.