Should patients with prosthetic joints take antibiotics before dental visits?
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Prosthetic joint infections are a serious health care complication following joint replacement surgery.
Dentists are responsible for around 10% of all antibiotics prescribed in the United States, and most are not in accordance with guidelines.
For years, it has been a common practice to prescribe prophylactic antibiotics to patients with prosthetic joints prior to invasive dental procedures to prevent potential late prosthetic joint infection (PJI).
We asked Debra Goff, PharmD, professor of pharmacy practice and an infectious diseases pharmacist at The Ohio State University Wexner Medical Center, and Andy O. Miller, MD, an associate attending physician at the Hospital for Special Surgery and associate professor of clinical medicine at Weill Cornell Medicine, if this practice is necessary.
This question has finally been answered based on a 2022 study titled “Analysis of Prosthetic Joint Infections Following Invasive Dental Procedures in England.” The answer is: no.
In England, antibiotic prophylaxis has never been recommended to prevent late PJI. This study of 9,427 late PJI hospital admissions in England for which dental records were available from 15 months preceding admission found no evidence of a temporal association between invasive dental procedures and late PJI. Patients with hip, knee or other implants were included.
The authors concluded there is no rationale to administer antibiotic prophylaxis before invasive dental procedures in patients with prosthetic joints. Orthopedic surgeon members of the Hip Society published a response and concluded there is no evidence to support prophylaxis before dental procedures in patients with late PJI. In addition to this definitive statement, they said, “Let’s hope the dentists stop calling us or asking us for letters.”
The American Dental Association and the American Academy of Orthopedic Surgeons need to co-author a statement to put this practice of unnecessary dental antibiotic prophylaxis to rest. Unnecessary prophylaxis contributes to antibiotic resistance, patient harm from adverse events and cost. Dental antibiotic stewardship initiatives can address this issue.
- References:
- Macauley W, Engh Jr. CA. J. Arthroplasty. 2022;doi:10.1016/j.arth.2022.02.082.
- Thornhill MH, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2021.42987.
Although a single 2 g dose of amoxicillin is very safe for most people, the literature does not demonstrate any convincing benefit for its use as prophylaxis before invasive dental procedures. Indeed, a very large recent study published in JAMA Open Network found that an invasive dental procedure was associated with a lower rate of PJI in the next 3 months. The data suggest that prophylaxis does not appear to prevent PJI — at all.
Perhaps some exceptions exist — some experts recommend prophylaxis for patients with many comorbidities or for those with very complex surgical anatomy; some centers recommend prophylaxis for the first 1 or 2 years after arthroplasty. Nevertheless, strong efforts should be made to strictly curtail the commonplace use of antibiotic prophylaxis for every patient at every dental visit.
- Reference:
- Thornhill MH, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2021.42987.
Click here to read the Cover Story, "Prosthetic joint infections: A ‘dreaded’ complication."
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