Episode 056: total joint replacement premedication rant

The Alan Mead Experience

Premedication for total joint replacement in the dental office has been common for a lot of years. We (mostly) shouldn't be doing it now. Al rants about this.

Premier Dental Periowise probe

Some links to read:
From the New England Journal of Medicine : “Staphylococci (S. aureus and coagulase-negative staphylococcus species) account for more than half of cases of prosthetic-hip and prosthetic-knee infection12 (Fig. 2). S. aureus infection is particularly common in patients with rheumatoid arthritis.13 Other bacteria and fungi cause the remainder of cases.14,15Propionibacterium acnes is a common cause of infection associated with shoulder arthroplasty.16 Up to 20% of cases are polymicrobial, most commonly involving methicillin-resistant S. aureus (MRSA) or anaerobes.17 Approximately 7% of cases are culture-negative, often in the context of previous antimicrobial therapy.18” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2850113/

From the CDC “Any medication can have serious side effects. For antibiotics, those side effects can include adverse drug reactions and Clostridium difficile infection (CDI).(8-11) Patients who are unnecessarily exposed to antibiotics are placed at risk for serious adverse events with no clinical benefit. The misuse of antibiotics has also contributed to the growing problem of antibiotic resistance, which has become one of the most serious and growing threats to public health.(12) Unlike other medications, the potential for spread of resistant organisms means that the misuse of antibiotics can adversely impact the health of patients who are not even exposed to them. The Centers for Disease Control and Prevention estimates more than two million people are infected with antibiotic-resistant organisms, resulting in approximately 23,000 deaths annually.(13)” (CDC)

AAOS guidelines

ADA Guidelines

"Meet the new guidelines, same as the old guidelines"