Case against antibiotic prophylaxis for dental treatment of patients with joint prostheses

Current international and national prophylactic antibiotic regimens have been analyzed in respect of the prevention of bacteremia after dental and surgical procedures and, therefore, of joint prosthesis infection. This information was used to formulate guidelines for the Department of Maxillofacial and Oral Surgery. Publications since 2003 were used in this research. In addition, recommendations of accredited institutions and associations were examined. These included the guidelines of the American Dental Association in association with the American Academy of Orthopaedic Surgeons (2003), the American Heart Association (2007), the Working Party of the British Society for Antimicrobial Chemotherapy (2006) and the Australian Dental Guidelines (2005). No guidelines published by any institution in South Africa were found. The general rationale for the use of antibiotic prophylaxis for surgical (including dental) interventions is that those procedures may result in a bacteremia that may cause infection in joint prostheses. Antibiotics, however, should therefore be administered to susceptible patients, e.g. immunocompromised patients, prior to the development of bacteremia. The guidelines recommended for use in South Africa are based solely on those used outside South Africa. South Africa is regarded as a developing country with its own population and demographic characteristics. Eleven percent of our population is infected with HIV, and a specific guideline for prophylactic antibiotic treatment is, therefore, essential.

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Acute Hematogenous Infection of Revision Total Hip Arthroplasty by Oral Bacteria in a Patient without a History of Dental Procedures: Case Report

The Open Orthopaedics Journal ◽

10.2174/1874325001408010056 ◽

2014 ◽

Vol 8 (1) ◽

pp. 56-59 ◽

Cited By ~ 4

Author(s):

Motoki Sonohata ◽

Masaru Kitajima ◽

Syunsuke Kawano ◽

Masaaki Mawatari

Keyword(s):

Total Hip Arthroplasty ◽

Antibiotic Prophylaxis ◽

Hip Arthroplasty ◽

Oral Bacteria ◽

Revision Total Hip Arthroplasty ◽

Total Hip ◽

Metastatic Infection ◽

Dental Procedures ◽

History Of ◽

Joint Prostheses

The risk of periprosthetic joint infection from hematogenous bacterial seeding is increased in patients undergoing dental procedures that facilitate the development of bacteremia. We herein report the case of a patient without a history of dental procedures who suffered from an acute metastatic infection of a hip prosthesis by the oral bacterium Streptococcus mutans 18 months after undergoing revision total hip arthroplasty. The patient was successfully treated by two-stage revision surgery. It is important to realize that the efficacy of antibiotic prophylaxis against joint infections has not yet been convincingly proven. As a result, optimal dental hygiene and regular dental visits may be more important than antibiotic prophylaxis for maintaining joint health. Therefore, orthopedic surgeons should educate patients with joint prostheses about good oral health.

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Antibiotic Prophylaxis for Dental Treatment in Patients with Immunodeficiency

The Journal of Allergy and Clinical Immunology In Practice ◽

10.1016/j.jaip.2019.01.016 ◽

2019 ◽

Vol 7 (3) ◽

pp. 819-823 ◽

Cited By ~ 4

Author(s):

Jacqueline D. Squire ◽

Pamela J. Gardner ◽

Niki M. Moutsopoulos ◽

Jennifer W. Leiding

Keyword(s):

Antibiotic Prophylaxis ◽

Dental Treatment

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Prescribing for the prevention of infective endocarditis: A study into the use of prophylactic antibiotics in the Armed Forces Dental Services

Journal of The Royal Naval Medical Service ◽

10.1136/jrnms-70-149 ◽

1984 ◽

Vol 70 (3) ◽

pp. 149-159

Author(s):

A. J. Woodman

Keyword(s):

Infective Endocarditis ◽

Antibiotic Prophylaxis ◽

Dental Treatment ◽

Armed Forces ◽

Prophylactic Antibiotics ◽

High Dose ◽

Dental Services ◽

Dental Practitioners ◽

Armed Services ◽

Responsible Manner

SummaryA review of the rationale for the use of antibiotic prophylaxis to prevent the effects of bacteraemia associated with dental treatment is presented with the background to the development of currently recommended high-dose prescribing. The results of a survey within the Armed Services into the current use of antibiotic prophylaxis indicate a wide variety of prescribing schedules, mostly considered effective by accepted standards. However, the use of antibiotics when penicillin hypersensitivity exists was often associated with doses considered ineffective against bacteraemia. The readiness to prescribe repeated prophylaxis was indicative of a lack of awareness of the problems of resistance within the Services for oral prophylaxis which was provided for most medical conditions in a responsible manner. Most replies indicated that there was room for improvement in communication between the patient and medical and dental practitioners regarding the dental involvement in infective endocarditis.

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Prosthetic Joint Infection Following Invasive Dental Procedures and Antibiotic Prophylaxis in Patients With Hip or Knee Arthroplasty

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.248 ◽

2016 ◽

Vol 38 (2) ◽

pp. 154-161 ◽

Cited By ~ 7

Author(s):

Feng-Chen Kao ◽

Yao-Chun Hsu ◽

Wen-Hui Chen ◽

Jiun-Nong Lin ◽

Ying-Ying Lo ◽

...

Keyword(s):

Antibiotic Prophylaxis ◽

Prosthetic Joint Infection ◽

Cox Regression ◽

Dental Treatment ◽

Joint Infection ◽

Prophylactic Antibiotics ◽

Prosthetic Joint ◽

Dental Procedures ◽

Cohort Difference ◽

Increased Risk

OBJECTIVESWe aimed to clarify whether invasive dental treatment is associated with increased risk of prosthetic joint infection (PJI) and whether prophylactic antibiotics may lower the infection risk remain unclear.DESIGNRetrospective cohort study.PARTICIPANTSAll Taiwanese residents (N=255,568) who underwent total knee or hip arthroplasty between January 1, 1997, and November 30, 2009, were screened.METHODSThe dental cohort consisted of 57,066 patients who received dental treatment and were individually matched 1:1 with the nondental cohort by age, sex, propensity score, and index date. The dental cohort was further divided by the use or nonuse of prophylactic antibiotics. The antibiotic and nonantibiotic subcohorts comprised 6,513 matched pairs.RESULTSPJI occurred in 328 patients (0.57%) in the dental subcohort and 348 patients (0.61%) in the nondental subcohort, with no between-cohort difference in the 1-year cumulative incidence (0.6% in both, P=.3). Multivariate-adjusted Cox regression revealed no association between dental procedures and PJI. Furthermore, PJI occurred in 13 patients (0.2%) in the antibiotic subcohort and 12 patients (0.18%) in the nonantibiotic subcohorts (P=.8). Multivariate-adjusted analyses confirmed that there was no association between the incidence of PJI and prophylactic antibiotics.CONCLUSIONSThe risk of PJI is not increased following dental procedure in patients with hip or knee replacement and is unaffected by antibiotic prophylaxis.Infect Control Hosp Epidemiol. 2017;38:154–161

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Health Technology Assessment Fireside: Antibiotic Prophylaxis and Dental Treatment in Canada

Journal of Pharmaceutics ◽

10.1155/2013/365635 ◽

2013 ◽

Vol 2013 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Mario A. Brondani

Keyword(s):

At Risk ◽

Health Technology Assessment ◽

Antibiotic Prophylaxis ◽

Technology Assessment ◽

Dental Treatment ◽

Research Question ◽

Health Technology ◽

Evidence Based ◽

Population Impact ◽

Dental Procedures

Objectives. This paper discusses the controversies surrounding the antibiotic prophylaxis preceding dental interventions within the following research question: how effective is dental antibiotic prophylaxis in preventing comorbidity and complications in those at risk? Methods. A synthesis of the available literature regarding antibiotic prophylaxis in dentistry was conducted under the lenses of Kazanjian’s framework for health technology assessment with a focus on economic concerns, population impact, social context, population at risk, and the effectiveness of the evidence to support its use. Results. The papers reviewed show that we have been using antibiotic prophylaxis without a clear and full understanding of its benefits. Although the first guideline for antibiotic prophylaxis was introduced in 1990, it has been revised on several occasions, from 1991 to 2011. Evidence-based clinical guidelines are yet to be seen. Conclusions. Any perceived potential benefit from administering antibiotic prophylaxis before dental procedures must be weighed against the known risks of lethal toxicity, allergy, and development, selection, and transmission of microbial resistance. The implications of guideline changes and lack of evidence for the full use of antibiotic prophylaxis for the teaching of dentistry have to be further discussed.

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