Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2016-11-22, 09:52:12 | version 1.38.0
antibiotics CE article | 15 roots 4 2016 prosthetic joint implants or other orthopedic im- plants undergoing dental procedures. “In the absence of reliable evidence linking poor oral health to prosthetic joint infections, it is the opinion of the work group that patients with pros- thetic joint implants or other orthopedic implants maintain appropriate oral hygiene.” Thereportalsostatedthattheaboverecommen- dations “are not intended to stand alone. Treat- ment decisions should be made in light of all cir- cumstances presented by the patient. Treatments andproceduresapplicabletotheindividualpatient rely on mutual communication between patient, physician, dentist and other healthcare practi- tioners.” In 2014, a panel of experts convened by the American Dental Association Council on Scientific Affairsdevelopedanevidence-basedclinicalprac- tice guideline on the use of prophylactic antibiot- ics in patients with prosthetic joints who are un- dergoing dental procedures. This clinical practice guideline was published in The Journal of the American Dental Association in January 2015 and contained the following recommendation: “In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recom- mended prior to dental procedures to prevent prosthetic joint infection. The practitioner and patient should consider possible clinical circum- stances that may suggest the presence of a signif- icant medical risk to providing dental care without antibioticprophylaxis,aswellastheknownrisksof frequent or widespread antibiotic use. As part of the evidence-based approach to care, this clinical recommendation should be integrated with the practitioner’s professional judgment and the pa- tient’s needs and preferences.”24 Summary Since their discovery eight decades ago, safe systemicantibioticshaverevolutionizedthetreat- ment of infections, transforming once deadly dis- eases into manageable health problems. However, the growing phenomenon of bacterial resistance, caused by the use and abuse of antibiotics and the simultaneous decline in research and develop- ment of new antimicrobial drugs, is now threaten- ing to take us back to the pre-antibiotic era. With- outeffectivetreatmentandpreventionofbacterial infections, we also risk rolling back important achievements of modern medicine such as major surgery,organtransplantationandcancerchemo- therapy.22 A fundamentally changed view of antibiotics is needed. They must be looked on as a common good, where individuals must be aware that their choice to use an antibiotic will affect the possibility of effec- tivelytreatingbacterialinfectionsinotherpeople.All antibiotic use, appropriate or not, “uses up” some of the effectiveness of that antibiotic, diminishing our ability to use it in the future. For current and future generations to have access to effective prevention and treatment of bacterial infections as part of their right to health, all of us need to act now. The window of opportunity is rapidly closing.22 _ Editorial Note: This article originally appeared in END- ODONTICS: Colleagues for Excellence, Winter 2012. Re- printed and updated with permission from the American Association of Endodontists, ©2012. The AAE clinical newsletterisavailableatwww.aae.org/colleagues. Acompletelistofreferencesisavailablefromthepublisher. author Dr Steven G.Morrow Having taught future oral health-care professionals at Loma Linda University School of Dentistry since 1965,Steven Morrow,DDS, MS,is currently a professor in the department of endodontics that he chaired from 1987 to 1990.He maintains responsibilities he accepted in 2000 as director of patient care services and clinical quality assurance.He was director,DistrictVI,of theAmerican Association of Endodontists from 1990 to 1993.He has also served as president of the Southern CaliforniaAcademy of Endodontics and as president of the California StateAssociation of Endodontists.In 1997,he earned diplomate status from theAmerican Board of Endodontics.Since 1998,he has been a fellow of theAmerican College of Dentists; and since 2003,he has served on the editorial review board of the Journal of Endodontics.A life member of theAmerican DentalAssociation,the AmericanAssociation of Endodontists and the California StateAssociation of Endodontists, he is currently serving his second term as a member of the Dental Board of California. Suggested Patient Type, Drug and Regimen for Antibiotic Prophylaxis for Total Prosthetic Joint Infection PatientType Drug Regimen* Patients not allergic to penicillin Cephalexin,cephradine or amoxicillin 2 g orally 1 hour prior to dental procedure Patients not allergic to penicillin and unable to take oral medication Cefazolin or ampicillin Cefazolin 1g or ampicillin 2 g IM or IV 1 hour prior to dental procedure Patients allergic to penicillin Clindamycin 600 mg orally 1 hour prior to dental procedure Patients allergic to penicillin and unable to take oral medication Clindamycin 600 mg IV 1 hour prior to dental procedure *Note:No second doses are recommended for any of these dosing regimens. (Tables:Provided byAmerican Association of Endodontists) Table 5 42016