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Routine use of antibiotic prophylaxis in patients with total joint prostheses remains controversial
According to researchers, routine antibiotic prophylaxis use before dental procedures in patients with total joint prostheses is controversial, as the practice may not be cost-effective when the patient’s risk of infection is low; however, routine antibiotic prophylaxis can still be considered for higher-risk patients with immunosuppression.
The researchers utilized a decision model to evaluate the cost-effectiveness of antibiotic prophylaxis before dental procedures for patients who previously underwent total joint replacement. To calculate the overall risk of complications, the researchers summed up the probabilities of the antibiotics used, the rate of clostridium difficile infection and the use of amoxicillin. Additionally, the researchers used two-way sensitivity analysis to examine the relationship between probability of infection of the total joint secondary to dental work and the probability of adverse drug reactions from antibiotic prophylaxis.
Results demonstrated that when the risk of an infected prosthesis is less than 0.75%, antibiotic prophylaxis was not cost-effective — regardless of how much the risk is reduced by the use of antibiotic prophylaxis administration. However, the researchers also found that when the risk of developing an infected prosthesis was 1.2%, administration of antibiotic prophylaxis would be cost-effective, as long as the antibiotics reduced the risk by at least 42%.
Furthermore, if the risk of an infected prosthesis was 2.1%, in order for the antibiotic prophylaxis to be cost-effective, the antibiotics would only need to reduce risk by 25% or more to be considered cost-effective. ‒ by Monica Jaramillo
Disclosures: Slover receives research support from Biomet and DJO LLC. Please see the full study for a list of all other authors’ financial disclosures.