Clinical guidelines are useful and generally beneficial for providing appropriate patient care, but they must be based on evidence. Only then can health care professionals evaluate and understand the rationale for implementing these approaches in a clinical setting. The global misuse of antibiotics has increased the incidence of microbial resistance to the point it has become a public health crisis.
Recently, the American Association of Orthopedic Surgeons unilaterally issued an informational statement regarding antibiotic prophylaxis for bacteremia (bacteria in the bloodstream) in patients who have undergone joint replacements. Rather than limiting the use of antibiotics, the revised guidelines EXPANDED it!
It’s always about risk versus benefit. The earlier recommendations did not seem to have produced any adverse effects. Other practice guidelines have recognized the harm in using antibiotics when not absolutely needed, yet the new statement could result in a substantial increase in the use of antibiotics, often for patients who do not need antibiotic coverage.
Yet, NO EVIDENCE documents the emergence of harmful treatment outcomes in individual patients or groups, the development of new criteria for treatment, or the availability of new treatment interventions that will improve clinical outcomes. The new guidelines overlook the documented risks without establishing any offsetting benefits.
So, what’s one to do?
For sure, if you’ve had a joint replacement, talk with your surgeon about the documentation of the necessity of antibiotic prophylaxis before dental care. Secondly, talk it over with your dentist, too.
Antibiotic overuse is a real danger that must be addressed; prophylaxis used indefinitely for all patients who have undergone a joint replacement carries risks that exceed any proven benefits.