Dental treatment, antibiotic prophylaxis and infection in joint prostheses : a review of new trends and recommendations in the literature

Abstract

OBJECTIVES : Current international and national prophylactic antibiotic regimens have been analysed in respect of the prevention of bacteraemia after dental and surgical procedures and therefore of joint prosthesis infection. This information was used to formulate guidelines for the Department of Maxillofacial and Oral Surgery. METHODS : Publications, since 2003, were used in this research. In addition recommendations of accredited institutions and associations were examined. These included the guidelines of the American Dental Association in association with the American Academy of Orthopaedic Surgeons (2003), the American Heart Association (2007), the Working Party of the British Society for Antimicrobial Chemotherapy (2006) and the Australian Dental Guidelines (2005). No guidelines published by any institution in South Africa were found. RESULTS : The general rationale for the use of antibiotic prophylaxis for surgical (including dental) interventions, is that those procedures may result in a bacteraemia that may cause infection in joint prostheses. Antibiotics, however, should therefore be administered to susceptible patients, e.g. immunocompromised patients, prior to the development of bacteraemia. CONCLUSION : The guidelines recommended for use in South Africa are based solely on those used outside South Africa. South Africa is regarded as a developing country with its own population and demographic characteristics. Eleven percent of our population is infected with HIV, and a specific guideline for prophylactic antibiotic treatment is therefore essential.