Antibiotic prophylaxis

Today’s topic is not very “sexy” but I did have a question about it this week. The question was how can you convince someone who thinks that they need antibiotic prophylaxis for an extraction (if, for example, they have a prosthetic joint) that they don’t in fact need it?

Let’s go through this step-by-step.

If the surgeon who placed the prosthetic joint told the patient that they need antibiotic prophylaxis for dental treatment then you should not dispute that advice.

The doctor who did the surgery knows far more about prosthetic joints than you do and saying that they are wrong will cause a no-win argument between you and the surgeon.

But, if you firmly believe that antibiotics are not necessary then you should not be the one to prescribe them.

Let the patient go back to their surgeon to get them. By doing it in that way you personally have not breached the guidelines.

Next, if the patient says they would be more comfortable if they had antibiotics then showing them the latest official guidelines may help. Because this is an official document it carries a lot of weight.

The relevant section says:

‘In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection’.

Note that the guideline says “In general…” It does not say “Always…” or “In all cases…”

If, after reading that the patient still wants antibiotics then you have a choice to make.

You can either go along with what the patient wants or you can dismiss them from the practice.

Personally, I would give them what they want but the choice is yours.