Antibiotic prophylaxis

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Editor, – I refer to previous correspondence on this matter ('Letters' Aust Prescr 1998;21:32-3).

The key issue in prescribing prophylactic antibiotics for arthroplasty patients undergoing dental procedures is not the choice of antibiotic, but the decision to prescribe at all. Bearing in mind the millions of potential episodes, the production of infection by dental bacteraemia, if it ever occurs, must be an extreme rarity and only a tiny number of cases provide any evidence for such a connection.1 Earlier reports proposing a link are seriously flawed, not least because staphylococci, the predominant pathogens in late prosthesis infection, are almost never found in dental bacteraemia.

The British Society for Antimicrobial Chemotherapy Working Party on Prophylaxis(assisted by orthopaedic input) considered the matter in 1992 and concluded that wide exposure of patients to antibiotics for this purpose was unjustified.2 No new information has since come forward to persuade us to change this view. The Americans have recently agreed.3 Some have argued - as a counsel of safety - that immunosuppressed patients or insulin dependent diabetics warrant extra protection4,but there is no evidence that even these patients are at risk from dentistry.

Optimum dental health and the prompt and effective treatment of dental sepsis will benefit any patient regardless of other considerations and is the true basis of prevention of distant infection.

David A. McGowan
Professor of Oral Surgery
Glasgow Dental School
University of Glasgow
Glasgow, Scotland

References

  1. Bartzokas CA, Johnson R, Jane M, Martin MV, Pearce PK, Saw Y. Relation between mouth and haematogenous infection in total joint replacements.Br Med J 1994;309:506-8.
  2. Simmons NA, Ball AP, Cawson RA, Eykyn SJ, Hughes SP, McGowan DA, et al. Case against antibiotic prophylaxis for dental treatment of patients with joint prostheses [letter]. Lancet 1992;339:301.
  3. American Dental Association; American Academy of Orthopaedic Surgeons. Advisory statement: Antibiotic prophylaxis for dental patients with total joint replacements. J Am Dent Assoc 1997;128:1004-8.
  4. Field EA, Martin MV. Prophylactic antibiotics for patients with artificial joints undergoing oral and dental surgery: necessary or not? Br J Oral Maxillofac Surg 1991;29:341-6.