Prescribing practices for antibiotic prophylaxis in patients with prosthetic joints

Abstract

Aims With the increasing number of patients with prosthetic joints, recommendations for antibiotic prophylaxis (AP) prior to dental procedures to prevent prosthetic joint infections (PJI) have changed. Methods and results This survey evaluated dentists’ AP practices for patients with prosthetic joints undergoing dental procedures and their familiarity with the American Dental Association Guidelines (ADA CPG) and American Academy of Orthopaedic Surgeons Appropriate Use Criteria (AAOS AUC). Dentists’ attitudes about antibiotic resistance, medical‐legal aspects, and adverse effects to using AP were examined. Dentists (n = 574) were familiar (51.2%) with ADA CPG and with the AAOS AUC (25.8%). Familiarity varied according to years since graduation. Female dentists (63.5%) were more likely to be very familiar with the ADA CPG than male dentists (49.5%). Overall, 65.4% of respondents believed that AP is not effective in the prevention of PJI, and 19.4% believed there is enough evidence to support AP. For a healthy patient, 28.9% of dentists would never recommend AP, 44.9% would recommend AP within the first two years since prosthetic joint replacement. Conclusions Dentists’ recommendations for the use of AP varied depending on different factors, including health status of the patient, dental procedure, time elapsed since joint surgery, suggesting that adherence to the ADA CPG and AUC is still challenging.

How decisions are made: Antibiotic stewardship in dentistry

“…Our survey revealed gaps in dentists' knowledge and confidence in antibiotic prescribing for dental conditions. Survey participants 2.66 ± 1.24 (1-5) [35] .867…”

“…2 ± 1.24 (1-5) [35] .206 Vignette 6: Prosthetic joint infection prophylaxis 3.12 ± 1.17 (1)(2)(3)(4)(5) [151] 3.19 ± 1.24 (1-5) [27] 3.37 ± 1.42 (1-5) [35] .553 Vignette 7: Endocarditis prophylaxis 2.95…”

“…Average across all 7 vignettes 2.72 ± 0.5 (1.14-4) [151] 2.48 ± 0.61 (1.29-4) [27] 2.6 ± 0.67 (1.14-4.43) [35] .095…”

“…External pressures, including risk of litigation, patient requests, and other healthcare providers’ requests for antibiotics are well recognized as influencing antibiotic prescribing decisions. 31,33 Higher-volume practices may also engage in more inappropriate antibiotic use 34 than lower-volume practices, whereas female dentists may be more likely to follow evidence-based practices 35 than male dentists. The COVID-19 pandemic may have exacerbated these problems.…”

Managing Oral Health in the Context of Antimicrobial Resistance

“…Furthermore, guidelines for the prudent usage of antibiotics were scarce or not generally shared among dental practitioners before [ 60 ]. Due to the advent of AMR, guidelines and recommendations have been created and updated by multiple national and international dental associations and expert groups [ 57 , 61 , 62 , 63 , 64 , 65 , 66 ]. Nonetheless, the guidelines for prudent antibiotic use can vary between countries, recommending different approaches based on the antibiotic resistance patterns known nationwide.…”