The Correct Answer is C!

 

A 65-year-old man is awaiting dental examination with a possible dental extraction. His history is noteworthy for coronary artery disease, hypertension, osteoarthritis, and total knee arthroplasty performed 3 years ago. He has no known drug allergies. Physical examination is unremarkable apart from a well-healed scar on the left knee.

Which of the following is the best choice for the prevention of prosthetic joint infection in this patient?

A. Doxycycline
B. Clindamycin
C. No prophylaxis is needed
D. Amoxicillin

 

Rationale:

In the most recent joint American Academy of Orthopedic Surgeons and American Dental Association clinical practice guidelines, routine prophylactic antibiotics in patients with prosthetic joints are not recommended. There has been no evidence to support that prophylactic antibiotic reduce the risk of prosthetic joint infection after a dental procedure. Antibiotic prophylaxis has been shown to decrease the incidence of post-procedure bacteremia, but there is no evidence that bacteremia leads to an increased incidence of prosthetic joint infection.

Some have suggested that patients undergoing “high risk” procedures be considered for prophylaxis if they have had a joint replacement within two years, are immunocompromised, or have comorbidities such as prior prosthetic joint infection, HIV infection, diabetes, malnourishment, malignancy, or hemophilia. However, the evidence to support these recommendations is still unclear. The patient in this case does not have the mentioned risk factors and had his joint replacement more than 2 years ago, so antibiotics are not indicated.

 

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