Antibiotic Prophylaxis for Patients with a History of Total Joint Replacement

Abstract

As the population ages and people remain active into the 7th and 8th decades of life, the frequency of total joint replacement is increasing. Following joint replacement surgery, patients inevitably require various invasive procedures as part of their routine health maintenance, including, but not limited to, dental care, colonoscopy, cystoscopy, and cardiac catheterization. There is scant evidence to support the use of periprocedural prophylactic antibiotics in the prevention of late total joint infection. The guidelines for the usage of periprocedural antibiotics have changed as knowledge of the pathophysiology of joint infection has evolved. We review the current recommendations from subspecialty academic organizations regarding antibiotic prophylaxis for patients undergoing routine urologic, gastrointestinal, dental, and cardiac procedures after total joint replacement. (J Am Board Fam Med 2016;29:500 -507.)

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

“…378 After thorough review of the then-available scientific evidence, the authors correctly concluded that there was no rationale to prescribe prophylactic antibiotics for patients with joint replacement to prevent prosthetic infections. This recommendation was confirmed in reviews that have been published since, 379,380 and new RCTs examining this matter have not been reported. Interestingly, despite the unchanged level of evidence, the American Academy of Orthopedic Surgeons (AAOS) published a new statement in 2017dapproved by the American Dental Associationdthat advises a renunciation from this very defensive approach.…”

Prescribing practices for antibiotic prophylaxis in patients with prosthetic joints

“…Most respondents would still recommend AP for the first years after joint replacement, which shows their level of knowledge does not reflect their current practice behavior. In some countries, the practice of recommending AP before a dental procedure is not even considered due to the lack of support for effectiveness while in others, it is a controversial topic …”

“…In some countries, the practice of recommending AP before a dental procedure is not even considered due to the lack of support for effectiveness 23 while in others, it is a controversial topic. 31,32 In the United States, the decision-making process of recommending AP for these patients is usually shared among physicians and dentists. 14,15 However, according to a recently published guest editorial in JADA, if the orthopedic surgeon recommends AP or the patient prefers it, the prescription should be provided by the surgeon despite the dentist's recommendation against premedication.…”

Bacterial (Septic) Arthritis and Prosthetic Joint Infection

“…В случае непереносимости фторхинолонов применяют аль-тернативные схемы: а) ампициллин 2 г в/в + гентамицин 1,5 мг/кг в/в или б) ванкомицин 1 г в/в в течение 1-2 ч + гентамицин 1,5 мг/кг в/в или в/м. В обоих случаях введение препаратов завершают за 30-60 мин до процедуры [22].…”