Antibiotic Prophylaxis for Prosthetic Joint Infection. This post will cover the points you need to know for your board exams as well as for teaching residents on the daily rounds. Please don't use the information here to treat your patients.
Generally speaking, antibiotic prophylaxis for prosthetic joint infection (PJI) is not indicated after 2 years of the implant surgery.
Before 2 years post operative, there is scant evidence in the benefit and hence the recommendations vary and are not strict. In general, a patient who is immunocompromised (HIV, SLE, RA or on immunosuppressants), Diabetics or history of PJI might be a candidate for antibiotic prophylaxis before dental or urologic procedures.
Suggested antibiotic prophylaxis for dental procedures:
- Patients not allergic to penicillin: cephalexin, cephradine, or amoxicillin: 2 grams orally 1 hour prior to dental procedure
- Patients not allergic to penicillin and unable to take oral medicine: cefazolin 1 gram or ampicillin 2 grams intramuscularly or intravenously 1 hour prior to procedure.
- Patients allergic to penicillin: clindamycin 600mg orally 1 hour prior to procedure
- Patients allergic to penicillin and unable to take oral medications: clindamycin 600mg intravenously 1 hour prior to procedure.
Suggested antibiotic prophylaxis for urological procedures:
- A single systemic level dose of a quinolone (e.g. ciprofloxacin 500mg or levofloxacin 500mg) orally 1-2 hours before the procedure
- Ampicillin 2 grams intravenously (or vancomycin 1 gram intravenously if allergic to ampicillin) PLUS gentamicin 1.5 mg/kg intravenously 1 hour before procedure
A guide for clinicians that is helpful in the antibiotic selection field is The Sanford Guide to Antimicrobial Therapy.
The information in this post is not for patients and shouldn't be used in treating patients. Please refer to your doctor for medical advice.