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PROTOCOL FOR ANTIBIOTICS AFTER JOINT REPLACEMENT
The development of infection following total joint replacement is a serious
problem. Although rare, there are documented cases of such infection caused
by bacteria introduced into the bloodstream during certain dental
procedures. Various approaches can be taken towards preventing this,
especially with regard to the use of antibiotics before undergoing a dental
procedure. The faculty has recently reviewed the medical literature and
advisory statement put forth by the American Academy of Orthopedic Surgeons
and the American Dental Association, and they offer the following
recommendations.
PROPHYLACTIC ANTIBIOTICS SHOULD BE GIVEN TO:
1) All patients who have had a joint replacement within two years,
regardless of the type of dental procedure or patient health status.
2) All patients, who are immunocompromised, have insulin dependant diabetes
mellitus, or systemic inflammatory disease such as rheumatoid arthritis or
systemic lupus erythematosis, regardless of how long ago they have had
surgery.
3) All patients, regardless of health status or how long ago they have had
surgery, who are having invasive dental procedures. These include
extractions, periodontal procedures, dental implant placement, root canals
or teeth cleaning likely to cause bleeding.
Prophylaxis should consist of a single 2-gram dose of amoxicillin or
cephalexin given orally one hour prior to the dental procedure.
In-patients, who are allergic to penicillin, 600mg of clindamycin may be
given instead. If a patient is unable to take oral medications, 1-gram of
IM/IV cephalexin or 2-grams of IV/IM ampicillin is recommended. Finally if
a patient is allergic to penicillin and unable to take oral medications a
single 600mg dose of IM/IV clindamycin should be taken one hour prior to the
dental procedure.
If you are undergoing a dental procedure, or even some other invasive
procedure such as cystoscopy or sigmoidoscopy, you should inform your
dentist or doctor that you have had a joint replacement. Please call our
office if you have additional questions or need a precription.
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