Joint Replacement Prophylaxis
Patients at Potential Increased Risk of Experiencing
Hematogenous Total Joint Infection
| PATIENT TYPE | CONDITION PLACING PATIENT AT RISK |
|---|---|
| All patients during first two years following joint replacement | Not Applicable |
| Immunocompromised or immunosuppressed patients | Inflammatory arthropathies such as rheumatoid arthritis |
| Systemic lupus erythematosus | |
| Drug- or radiation-induced immunosuppression | |
| Patients with comorbidities | Examples are: |
| Previous prosthetic joint infections | |
| Malnourishment | |
| Hemophilia | |
| HIV infection | |
| Insulin-dependent diabetes | |
| Malignancy |
Incidence Stratification of Bacteremic Dental Procedures
| INCIDENCE | DENTAL PROCEDURE |
|---|---|
| Higher incidence | Dental extractions |
| Periodontal procedures, including surgery, subgingival placement of antibiotic fibers/strips, scaling and root planing, probing, recall maintenance | |
| Dental implant placement and replantation of avulsed teeth | |
| Endodontic (root canal) instrumentation or surgery beyond the apex | |
| Initial placement of orthodontic bands but not brackets | |
| Intraligamentary and intraosseous local anesthetic injections | |
| Prophylactic cleaning of teeth or implants where bleeding is anticipated | |
| Lower incidence (prophylaxis not indicated) | Restorative dentistry (operative and prosthodontic) with/without retraction cord |
| Local anesthetic injections (non-intraligamentary and non-intraosseous) | |
| Intracanal endodontic treatment; placement of post and buildup | |
| Placement of rubber dam | |
| Postoperative suture removal | |
| Placement of removable prosthodontic/orthodontic appliances | |
| Taking of oral impressions | |
| Fluoride treatments | |
| Taking of oral radiographs | |
| Orthodontic appliance adjustment |
Suggested Drug and Regimen
| PATIENT TYPE | SUGGESTED DRUG | REGIMEN (1-dose only) |
|---|---|---|
| Patients not allergic to penicillin | Cephalexin, cephradine or dental amoxicillin | 2 grams orally 1 hour prior to procedure |
| Patients not allergic to penicillin and unable to take oral medications | Cefazolin or ampicillin | Cefazolin 1 g or ampicillin 2 g intramuscularly or intravenously 1 hour prior to dental procedure |
| Patients allergic to penicillin | Clindamycin | 600 milligrams orally 1 hr prior to dental procedure |
| Patients allergic to penicillin and unable to take oral medications | Clindamycin | 600 milligrams intravenously 1 hr prior to dental procedure |