What antibiotics should be given to a patient with a recent thumb Ulnar Collateral Ligament (UCL) repair with tendon graft and suture anchor undergoing a dental procedure one week post-operatively?

Antibiotic Prophylaxis for Dental Procedures After Thumb UCL Repair

No antibiotic prophylaxis is indicated for a patient who had a thumb UCL repair with tendon graft and suture anchor undergoing a dental procedure one week later, unless the patient has specific cardiac conditions that would independently warrant prophylaxis.

Rationale for No Prophylaxis

• Current guidelines do not recommend routine antibiotic prophylaxis for patients with orthopedic implants (including suture anchors) undergoing dental procedures 1
• There is insufficient evidence that antibiotic prophylaxis reduces the incidence of hematogenous periprosthetic joint infections from dental procedures 1
• The 2018 World Society of Emergency Surgery/Surgical Infection Society-Europe consensus recommends limiting antibiotic prophylaxis to the operative period only, with no evidence supporting post-procedural antibiotics 2

Specific Considerations for Thumb UCL Repair

• Thumb UCL repair with suture anchor is considered a clean orthopedic procedure with foreign material implantation 3
• While prophylactic antibiotics are recommended during the initial surgery, there is no evidence supporting continued prophylaxis for subsequent dental procedures 2
• The suture anchor used in UCL repair is minimal implanted material compared to joint prostheses, further reducing any theoretical risk 3, 4

Exception: Patients with Specific Cardiac Conditions

If the patient has any of the following cardiac conditions, antibiotic prophylaxis would be indicated for dental procedures according to American Heart Association guidelines:

• Prosthetic cardiac valves
• Previous infective endocarditis
• Congenital heart disease (specific types)
• Cardiac transplant with valve regurgitation 2

Recommended Antibiotic Regimen IF Prophylaxis Is Required

For patients with cardiac conditions listed above requiring prophylaxis:

• First choice: Amoxicillin 2g orally 30-60 minutes before the dental procedure 2, 5
• For penicillin-allergic patients: Clindamycin 600mg orally 30-60 minutes before the procedure 6, 5
• Alternative for penicillin-allergic patients: Azithromycin 500mg orally 30-60 minutes before the procedure (shown to have higher efficacy than clindamycin) 5

Important Clinical Considerations

• Good oral hygiene and regular dental care are more important for preventing infections than antibiotic prophylaxis 1
• Unnecessary antibiotic prophylaxis contributes to antibiotic resistance and exposes patients to potential adverse effects 2, 7
• The risk of bacteremia from routine daily activities (brushing teeth, flossing) may exceed that from a single dental procedure 2

Special Situations

• If the patient is already receiving antibiotics for another condition, select an antibiotic from a different class for prophylaxis if it is required 2
• If the patient is on anticoagulants, oral antibiotics are preferred over intramuscular injections 2
• If the patient has signs of active oral infection at the time of the dental procedure, treatment of the infection is appropriate, regardless of the UCL repair 2