ADA: Routine antibiotics not needed for patients with orthopedic implants

There is insufficient evidence to recommend the routine use of antibiotics for patients with orthopedic implants to prevent infections prior to having dental procedures because there is no direct evidence that routine dental procedures cause prosthetic joint infections, according to new recommendations from the ADA and the American Academy of Orthopaedic Surgeons (AAOS).

The recommendations are based on a collaborative evidence-based clinical practice guideline that focuses on the possible linkage between orthopedic implant infection and patients undergoing dental procedures.

"As clinicians, we want what is in the best interest of our patients, so this clinical practice guideline is not meant to be a stand-alone document. Instead it should be used as an educational tool to guide clinicians through treatment decisions with their patients in an effort to improve quality and effectiveness of care," David Jevsevar, MD, MBA, chair of the AAOS Evidence Based Practice Committee, stated in a press release.

It has been long debated that patients with orthopedic implants, primarily hip and knee replacements, are prone to implant infections from routine dental procedures, he added.

"What we found in this analysis is that there is no conclusive evidence that demonstrates a need to routinely administer antibiotics to patients with an orthopedic implant, who undergo dental procedures," Dr. Jevsevar said.

The new guidelines are based primarily on clinical research that examined a large group of patients, all having a prosthetic hip or knee and half with an infected prosthetic joint, according to Elliot Abt, DDS, MS, MSc, a general dentist in Skokie, IL, and a member of the ADA Council on Scientific Affairs who served as member of the AAOS-ADA work group.

In 2010, more than 302,000 hip replacement and 658,000 knee replacement procedures were performed in the U.S., according to the organizations. Infections can occur when foreign organisms enter the wound during or at any point following joint replacement, and can lead to additional surgery and prolonged antibiotic treatment.

"The research showed that invasive dental procedures, with or without antibiotics, did not increase the odds of developing a prosthetic joint infection," he said.

The new guideline comprises three recommendations:

  1. Recommendation one, which is based on limited evidence, supports that practitioners consider changing their longstanding practice of prescribing prophylactic antibiotics for patients who undergo dental procedures. Limited evidence shows that dental procedures are unrelated to prosthetic joint infection (PJI).

  2. Recommendation two addresses the use of oral topical antimicrobials (topical antibiotic administered by a dentist) in preventing PJI in patients undergoing dental procedures. There is no direct evidence that the use of oral topical antimicrobials before dental procedures will prevent PJI.

  3. Recommendation three is the only consensus recommendation in the guideline, and it supports the maintenance of good oral hygiene.

"Research is always changing and we need to work to improve clinical research databases, so in the future any type of prospective research done in this area will help shed light on prophylaxis and orthopedic infection rates," Dr. Jevsevar said.

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