AAOS Releases Statement on Antibiotics After Arthroplasty
Comprehensive “information statement” puts patient safety first
In February 2009, the American Academy of Orthopaedic Surgeons (AAOS) Board of Directors approved the release of the information statement “Antibiotic Prophylaxis for Bacteremia in Patients with Joint Replacements.” The new statement asserts that “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 .”
Click here to read the complete article in the AAOS Now, May 2009 Issue
| Prophylactic antibiotic recommendations for different procedures | ||||
| Procedure | Antimicrobial Agent | Dose | Timing | Duration |
| Dental | Cephalexin, cephradine, amoxicillin | 2 gm PO | 1 hour prior to procedure | Discontinued within 24 hours of the procedure. For most out patient/ office-based procedures a single pre-procedure dose is sufficient. |
| Ophthalmic | Gentamicin, tobramycin, ciprofloxacin, gatifloxacin, levofloxacin, moxifloxacin, ofloxacin, or meomycin- gramicidin-polymyxin B cefazolin | Multiple drops topically over 2 to 24 hours or 100 mg subconjunctivally | Consult ophthalmologist or pharmacist for dosing regimen | |
| Orthopaedic | Cefazolin | 1-2 g IV | Begin dose 60 minutes prior to procedure | |
| Cefuroxime OR | 1.5 g IV | |||
| Vancomycin | 1g IV | |||
| Vascular | Cefuroxime OR | 1.5 g IV | Begin dose 60 minutes prior to procedure | |
| Vancomycin | 1 g IV | |||
| Gastrointestinal | ||||
| Esophageal, gastroduodenal | Cefazolin | 1-2 g IV | Begin dose 60 minutes prior to procedure | |
| Biliary Tract | Cefazolin | 1-2 g IV | ||
| Colorectal | Neomycin + erythromycin base (oral) OR | 1 g | Dependent on time of procedure, consult with GI physician and/or pharmacist | |
| metronidazole (oral) | 1g | |||
| Head and Neck | Clindamycin + | 600-900 mg IV | Begin dose 60 minutes prior to procedure | |
| gentamicin OR | 1.5 mg/kg IV | |||
| Cefazolin | 1-2 g IV | |||
| Obstetric and Gynecological | Cefoxitin, cefazolin, | 1-2 g IV | Begin dose 60 minutes prior to procedure | |
| Ampicillin/sulbactam | 3 g IV | |||
| Genitourinary | Ciprofloxacin | 500 mg PO or | 1 hour prior to procedure | |
| 400 mg IV | Begin dose 60 minutes prior to procedure | |||
By Mary Ann Porucznik