Prophylactic antibiotics for life

Any dental work, cellulites, cystoscopy, sigmoidoscopy, proctoscopy, and related procedures will require prophylactic antibiotics.

Now that you have a joint replacement, it is very important for you to take a dose of antibiotics before any procedure or event that may introduce bacteria into your bloodstream. Taking the appropriate antibiotics will help prevent the occurrence of an infection in your joint.

You should not have any elective dental work or procedures involving the respiratory, digestive or urinary tract within 3 months following your joint replacement. Obviously emergency procedures or procedures to treat an infection are permitted.

Dental Work

We recommend a dose of antibiotics before any type of dental work, to include routine dental cleanings. We recommend this “pre-treatment” as a lifelong precaution for patients with joint replacements.

  • If you are not allergic to penicillin, you should take 2 grams of cephalexin, cephradine or amoxicillin by mouth 1 hour prior to any dental procedure.
  • If you are allergic to penicillin, you should take 600 milligrams of clindamycin 1 hour prior to any dental procedure.

Your dentist or primary care provider should be able to prescribe these antibiotics for you. If your dentist has any questions, (s)he should feel free to contact a member of the Arthritis Team.

Non Dental Procedures

Given the potential adverse outcomes and cost of treating an infected joint replacement, the American Academy of Orthopaedics Surgeons recommends that clinicians consider antibiotic prophylaxis for all total joint replacement patients prior to any invasive procedure that may cause bacteria to enter the bloodstream. These are their prophylactic antibiotic recommendations:
 

Procedure|Antimicrobial Agent|Dose|Timing|Duration
Dental|Cephalexin, cephradine, amoxicillin|2 gm PO|1 hour prior to procedure|Discontinued within 24 hours of the procedure.~~ ~~For most outpatient and office-based procedures a single pre-procedure dose is sufficient. Ophthalmic|Gentamicin, tobramycin, ciprofloxacin, gatifloxacin, levofloxacin, moxifloxacin, ofloxacin, or meomycin-gramicidin-polymyxin B cefazolin|Multiple drops topically over 2 to 24 hours or 100 mg subconjunctivally|Consult ophthalmologist or pharmacist for dosing regimen
Orthopaedic†|CefazolinCefuroxime OR Vancomycin|1-2 g IV~~1.5 g IV~~1 g IV|Begin dose 60 minutes prior to procedure
Vascular|Cefazolin OR Vancomyin|1-2 g IV~~1 g IV|Begin dose 60 minutes prior to procedure
Gastrointestinal| | | 
Esophageal, gastroduodenal|Cefazolin|1-2 g IV|Begin dose 60 minutes prior to procedure
Biliary tract|Cefazolin|1-2 g IV| 
Colorectal |Neomycin + erythromycin base (oral)|1 g|Dependent on time of procedure, consult with GI physician and/or pharmacist OR metronidazole (oral)|1 g

Head and neck|Clindamycin + gentamicin OR cefazolin|600-900 mg IV~~1.5 mg/kg IV~~1-2 g IV|Begin dose 60 minutes prior to procedure
Obstetric and gynecological|Cefoxitin, cefazolin~~Ampicillin/sulbactam|1-2 g IV~~3 g IV|Begin dose 60 minutes prior to procedure

Genitourinary|Ciprofloxacin|500 mg PO or~~400 mg IV|1 hour prior to procedure~~Begin dose 60 minutes prior to procedure

If your surgeon, primary care provider or dentist has any questions regarding prophylactic antibiotics, please have them contact Performance Orthopedics (248) 988-8085.

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