As medical experts around the world debate how to reduce the growing dependence on antibiotics and stave off the dangers of antimicrobial resistance, the New American Academy of Orthopaedic Surgeons (AAOS) has announced criteria for using antibiotics prior to various dental procedures to prevent the infection of orthopaedic replacement joints or implants.
Most patients with replacement hip, knee, shoulder, or other implants aren’t at risk for infection following dental procedures. But patients with severely compromised immune systems due to AIDS, uncontrolled diabetes, or chemotherapy; a recent history of joint infections; and prescriptions for specific drugs for rheumatoid arthritis or to prevent organ transplant complications should be considered for antibiotic administration before dental procedures, according to the AAOS.
Infections may occur during dental procedures involving these patients when bacteria travel through the bloodstream to the implant, which cannot fight them off. A severe infection most likely would require surgery at the site of the implant infection and may even cause death, the AAOS reports.
Infections can be dangerous, so “surgeons and dentists prefer to err on the side of caution in the most high-risk patients,” said Robert H. Quinn, MD, Appropriate Use Criteria (AUC) section leader of the AAOS Committee on Evidence-Based Quality and Value. Yet the AAOS also is aware of how antibiotic overuse throughout the healthcare system has made many types of bacteria resistant to treatment.
“These guidelines will hopefully help to decrease antibiotic use in patients with artificial joints, but still provide reasonable scenarios when they might be considered,” said Quinn.
Available through the AAOS OrthoGuidelines website and app, the AUC include questions for clinicians to gauge risk related to the type of dental procedure, given the patient’s implant status and overall health. There are 64 scenarios, each with an antibiotic “appropriateness rating” of one to 9.
A rating between 7 and 9 means that antibiotic use is “appropriate for the indication provided… and is likely to improve the patient’s health outcomes or survival.” With a rating of 4 to 6, antibiotics “may be appropriate.” A score of one to 3 would mean antibiotics would be “rarely appropriate.” Specific antibiotics and dosage are provided for scenarios when antibiotic treatment is recommended.