Recently American Academy of Orthopaedic Surgeons published new guidelines for antibiotic prophylaxis in patients with joint replacement. In brief, it is suggested that patients with prosthetic joint replacement and patients with co-morbidities or immunosuppresion should receive antibiotic prophylaxis (2 gr cephalexin or cephradine or amoxicillin) 1 hour prior to any invasive dental procedure.
The full list of the patients that need antibiotic prophylaxis is provided in the document. No further information are provided on the type of the dental procedure that requires the supplemental prescription of antibiotics.
A debate in the Journal of Canadian Dental Association has arised in regards the validity of the recommendations. The new statement was not developed collaboratively with the American Dental Association, but is intended “as an educational tool based on the opinion of the authors.” (Napeñas et al. 2009) The basic elements of the argument are the lack of link of organisms colonising the mouth with prosthetic joint infections, the low incidence of prosthetic joint infections in the population (0,06 cases per 1.000 joints-years), evidence for the occurence of bacteremia following extractions despite the antibiotic prophylaxis administration and lack of evidence for temporal relation between dental procedures and the onset of prosthetic joint infections. (Napeñas et al. 2009) (Morris and Howie 2009) Adding all these thoughts to the fact of development resistance to antibiotics and the overuse of antibiotics by dental practitioners, the recommendations of the American Association of Orthopaedic Surgeons seem to be indenfesible. (Morris and Howie, 2009)
American Association of Orthopaedic Surgeons. Information statement: antibiotic prophylaxis for bacteremia in patients with joint replacements. February 2009. Available: www.aaos.org/about/papers/advistmt/1033.asp
Bartzokas CA et al. Relation between mouth and haematogenous infections in total joint replacement. BMJ 1994;309:506-508. http://www.bmj.com/cgi/content/full/309/6953/506
Ching DW et al. Prevention of late haematogenous infection in major prosthetic joints. J Antimicrob Chemother 1989;23:676-680.
Guntheroth WG: How important are dental procedures as a cause of infective endocarditis? Amer J Cardiol 1984;54:797-801.
Morris and Howie. Recommendations for antibiotics in patients with joint prosthesis are irresponsible and indefensible. Journal (Canadian Dental Association) (2009) vol. 75 (7) pp. 513-5 http://www.cda-adc.ca/jcda/vol-75/issue-7/513.pdf
Napeñas et al. Comment on the 2009 American Academy of Orthopaedic Surgeons' information statement on antibiotic prophylaxis for bacteremia in patients with joint replacements. Journal (Canadian Dental Association) (2009) vol. 75 (6) pp. 447-9 http://www.cda-adc.ca/jcda/vol-75/issue-6/447.pdf
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