Seeking Clarity on Antibiotic Prophylaxis Position Statements

The news item¹ that appeared in the recent issue of JCDA implies that CDA, the American Dental Association (ADA), and the American Academy of Orthopaedic Surgeons (AAOS) are in agreement regarding prophylactic antibiotic regimens for dental patients with total joint replacements.

The AAOS modified its position in a 2009 Information Statement² and it now states, “Given the potential adverse outcomes and cost of treating an infected joint replacement, the AAOS recommends that clinicians consider antibiotic prophylaxis for all total joint replacement patients prior to any invasive procedure that may cause bacteremia.”

This seems to indicate a significant difference of opinion between the 3 organizations, as the AAOS position does not limit antibiotic prophylaxis for patients to the first 2 years following joint replacement surgery.

Although I do not disagree with the CDA position, I think the information that appeared in JCDA should have stated more clearly that the AAOS has changed its recommendations from those it made in 2003.

NOTE: J Can Dent Assoc 2012;78:c13 includes links to all position statements referenced above.

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CDA Responds

Cite this response as: J Can Dent Assoc 2012;78:c40

Thank you for your letter concerning antibiotic prophylaxis for dental patients with total joint replacement.

In 2003, the American Dental Association (ADA) worked with the American Academy of Orthopaedic Surgeons (AAOS) to issue a joint statement which was endorsed by CDA.

Unfortunately, in 2009 the AAOS forced the withdrawal of the joint statement when it issued an Information Statement¹ (revised in 2010) independently of the ADA. After reviewing the AAOS statement, CDA concluded that adhering to its recommendations would result in an overprescription of antibiotics. Therefore, CDA maintained its support for the approach recommended in the withdrawn statement.

Being well aware of the difficulties created by the coexistence of contradictory recommendations, the ADA and AAOS have joined forces once again and are presently developing an evidenced-based guidance document. They have asked several key stakeholders, including CDA, to participate. Two members of CDA’s Committee on Clinical and Scientific Affairs are currently reviewing the draft guidance document.

Until the anticipated release of a new guidance document from the ADA and AAOS in 2012, all parties (patients, dentists and orthopedic surgeons) must use their judgment to decide what is the best available information to guide them with decisions concerning the need for antibiotic prophylaxis.