To Antibiotic Or Not Antibiotic?

Antibiotics are described as “types of antimicrobial used specifically against bacteria, and often used in medical treatment of bacterial infections to either kill or inhibit the growth of bacteria.”

Patients who have had joint replacement surgery are aware of risks of the implant developing infections. Our immune systems may find it difficult to fight bacteria that appears in the bloodstream and difficulty combating infection often results. Knee and hip replacement infections are serious complications, so it’s important to prevent many types of bacteria from entering our bodies much as possible.

Enter antibiotic pre-treatment, which is usually recommended for invasive procedures that include several types of dental work (including basic cleaning). Recommendations for such preventive measures may vary with each doctor or dentist, but it never hurts to remain on the safe side by checking with a medical or dental professional prior to having any invasive procedures.

Most would be surprised by the numbers of bacteria that live in our mouths and noses. One wrong can easily free such bacteria and travel to joint implants faster than we can imagine. Antibiotic treatment may be necessary before having joint replacement surgery in some cases. For example, I had a nose culture taken as part of pre-op testing and a trace of MRSA turned up in my lab results. A week’s worth of Bactroban twice a day followed before I went into the hospital, and both orthopedist and dentist warned I’d likely need antibiotic pre-treatments for the rest of my life (I also have mild mitral regurgitation, so it’s better safe than sorry in my case).

The antibiotic pre-treatment debate goes on; while a 2012 study showed that pre-treatment is not mandatory for routine dental work after having total joint replacements, there are some patients at risk for developing infections for other medical reasons such as HIV, insulin-dependent diabetes, cancer treatments, organ transplants, history of artificial joint infections, hemophilia, and cardiac conditions such as mitral valve prolapse/regurgitation to name a few.

Antibiotics usually prescribed for pre-treatment are Amoxicillin (usually in oral form), Cefazolin or Ampicillin (the latter being injections for those who cannot tolerate oral antibiotics), which gets injected within one hour of the procedure. Clindamycin (either oral or injected) may be prescribed for patients with allergies to regular types of antibiotics.

It is especially critical for patients with histories of joint implant infections to have antibiotic treatments before major dental and additional surgical procedures. Pre-treatments as usually done an hour prior to surgery or dental work, but may be altered by your dentist and/or orthopedist. In any event, it’s best to let all medical professionals know your complete history, including having a joint implant. Your health and mobility depend on it!


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