From the Guidelines
For patients with a history of infected prosthetic joints, oral antibiotic options for prophylaxis include rifampicin plus levofloxacin, ciprofloxacin, or fusidic acid, among others, as outlined in the table from the study published in Clinical Microbiology and Infection 1. When considering oral antibiotic options, it's crucial to select agents based on the suspected or known infectious agent, as well as the patient's susceptibility profile and potential drug interactions.
- The choice of oral antibiotic should prioritize excellent bioavailability to ensure effective treatment.
- Rifampicin must always be combined with a second agent to reduce the likelihood of resistance emergence, with suggested companion drugs including levofloxacin, ciprofloxacin, fusidic acid, minocycline, trimethoprim-sulfamethoxazole, clindamycin, linezolid, and doxycycline, as indicated in the study 1.
- For specific infectious agents, such as Staphylococcus species, Streptococcus species, Enterococcus species, Cutibacterium acnes, and Gram-negative bacteria, particular oral antibiotic regimens are recommended, as detailed in the study 1. The decision to use oral antibiotics for prophylaxis in patients with a history of infected prosthetic joints should be made on a case-by-case basis, taking into account the patient's individual risk factors, the type of procedure, and the potential benefits and risks of antibiotic prophylaxis, as suggested by the study 1.
From the Research
Oral Antibiotic Options for Prophylaxis
- The use of oral antibiotic regimens for prophylaxis in patients with a history of infected prosthetic joints is not widely recommended 2.
- However, some studies suggest that oral antibiotics such as amoxicillin, erythromycin, or clindamycin may be used in certain cases 3.
- A simulation model analysis suggested that oral penicillin or cephalexin regimens may be considered for dental patients at risk for late prosthetic joint infection (LPJI), but the risks and benefits must be carefully weighed 4.
Specific Oral Antibiotics
- Amoxicillin is mentioned as an option for oral antibiotic prophylaxis in patients with prosthetic joints 3.
- Erythromycin and clindamycin are also listed as possible oral antibiotic options for prophylaxis in patients with prosthetic joints 3.
- Cephalexin is another oral antibiotic that has been considered for prophylaxis in patients with prosthetic joints, particularly in those at risk for LPJI 4.
Guidelines and Recommendations
- The American Dental Association Council on Scientific Affairs recommends that prophylactic antibiotics are not necessary for most patients with prosthetic joints undergoing dental procedures 2.
- The American Academy of Orthopaedic Surgeons has published guidelines for antibiotic prophylaxis to prevent prosthetic joint infections, but these guidelines do not specifically recommend oral antibiotics for prophylaxis 5.