Antibiotic Prophylaxis in Artificial Joint Patients

Abstract

—I enjoyed reading “Oral Bacteremia as a Cause of Prosthesis Failure in Patients With Joint Replacements” 1 Assael L.A. Oral bacteremia as a cause of prosthesis failure in patients with joint replacements. J Oral Maxillofac Surg. 2009; 67: 1789 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar in the September 2009 issue of the Journal, and I concur that the 2009 American Academy of Orthopaedic Surgeons (AAOS) Information Statement on antibiotic prophylaxis for patients with total joint replacements 2 American Academy of Orthopaedic SurgeonsInformation statement: Antibiotic prophylaxis for bacteremia in patients with joint replacements. http://www.aaos.org/about/papers/advistmt/1033.aspDate: February 2009 Google Scholar is at best a travesty, not based on any new information or scientific evidence. However, you state that the AAOS recommends antibiotic prophylaxis for all artificial joint patients undergoing dental procedures. Neither the 1997 AAOS/American Dental Association (ADA) statement, 3 American Dental Association, American Academy of Orthopaedic SurgeonsAntibiotic prophylaxis for dental patients with total joint replacements. J Am Dent Assoc. 1997; 128: 1004 Crossref PubMed Scopus (29) Google Scholar the 2003 AAOS/ADA statement, 4 American Dental Association, American Academy of Orthopaedic SurgeonsAntibiotic prophylaxis for dental patients with total joint replacements. J Am Dent Assoc. 2003; 134: 895 Crossref PubMed Scopus (163) Google Scholar nor the 2009 AAOS statement recommended or recommends antibiotic prophylaxis for any dental patients to prevent artificial joint infections. 2 American Academy of Orthopaedic SurgeonsInformation statement: Antibiotic prophylaxis for bacteremia in patients with joint replacements. http://www.aaos.org/about/papers/advistmt/1033.aspDate: February 2009 Google Scholar Instead, the 1997 and 2003 statements recommended that antibiotic prophylaxis be “considered” for some high-risk artificial joint dental patients. The 2009 statement recommends that antibiotic prophylaxis be “considered” for all artificial joint dental patients. In addition, the 2009 statement points out that “Readers are encouraged to consider the information presented and reach their own conclusions” [emphasis original]. The statement goes on: “The treating clinician is ultimately responsible for making treatment recommendations for his/her patients based on the clinician's professional judgment. Any perceived potential benefit of antibiotic prophylaxis must be weighed against the known risks of antibiotic toxicity, allergy, and development, selection, and transmission of microbial resistance. Practitioners must exercise their own clinical judgment in determining whether or not antibiotic prophylaxis is appropriate.”