Abstract
Background:
Antibiotic prophylaxis prior to dental and other procedures when patients have joint replacements in situ remains controversial. Recommendations seem to generally be intuitive and not based on any sound scientific evidence. Recently, the American Academy of Orthopaedic Surgeons altered their previous standpoint and suggested that orthopaedic surgeons review their current practice of routine prescription of antibiotic prophylaxis.
Method:
We conducted an electronic survey of members of the South African Orthopaedic Association to determine the opinion of the average orthopaedic surgeon in South Africa in respect of this prophylaxis. 111 surgeons responded.
Results:
73% of respondents were of the opinion that patients with joint replacements in situ should take antibiotic prophylaxis prior to undergoing any dental procedure. 65% of surgeons were of the opinion that this prophylaxis should be life-long. 59% of surgeons recommended that prophylaxis start before the procedure, 24% at the same time as the procedure. 35% of surgeons recommended prophylaxis with every dental procedure, and 61% only with more invasive procedures. We also show that working in private practice and greater surgical experience increases the likelihood that surgeons will prescribe prophylactic antibiotics prior to dental procedures.
Scientific evidence linking bacteraemia from dental procedures with infected prosthetic implants is limited, however 19% of surgeons reported managing an infected implant as a result of dental surgery.
Conclusion:
We could find no evidence to substantiate the practice of using antibiotic prophylaxis prior to dental or any other procedures in those patients with joint replacements in situ. Practice in South Africa is at odds with world-wide trends and we would recommend that these patients do not use antibiotic prophylaxis prior to dental and other procedures, except possibly those that may be immune-compromised.
