Antibiotic Prophylaxis for Patients with a History of Total Joint Replacement

Article Figures & Data

Table 1.

Summary of Antibiotic Prophylaxis Recommendations^{2,8,14,16,20,30,31,34}

Type of Procedure	Recommending Organization	Antibiotics Recommended?	Regiment
Urologic	American Urologic Association	Yes, in high-risk patients or procedures¹⁶^*	Fluoroquinolone PO 1–2 hours preoperatively OR ampicillin + gentamicin 30–60 minutes preoperatively
Gastrointestinal	American Society of Gastroenterologists/American Society of Colon and Rectal Surgeons	No	N/A
Dental	American Academy of Orthopaedic Surgeons	No^{^†}	Cephalexin 2 g PO 1 hour before
Dental	American Dental Association	No^9,26,31	N/A
Cardiac	American Heart Association	Preoperatively for all CIEDs; not recommended before other invasive procedures or postoperatively¹⁰	Cefazolin 1 hour preoperatively or vancomycin 2 hours preoperatively

↵* Defined by the American Urologic Association as patients within 2 years of their joint replacement; immunocompromised patients; or patients with previous joint infections, malnourishment, hemophilia, HIV infection, diabetes, or malignancy. High-risk procedures include kidney stone manipulation, ureteroscopy, percutaneous nephrolithotomy, extracorporeal shock wave lithotripsy, transrectal prostate biopsy, and bowel manipulation. Other high risks include patients with indwelling catheters, clean intermittent catheterization, urinary retention, recent urinary tract infection, indwelling ureteral stent, or urinary diversion.
↵† Should be addressed on a patient-by-patient basis and incorporate both patient and physician preference as well as the presence of risk factors for infection, such as immunocompromised patients; those with inflammatory arthropathy; immunosuppressed patients; patients with HIV; those with previous joint infection, hemophilia, type 1 diabetes, or malignancy; and patients with a megaprostheses.
CIED, cardiac implantable electronic device; N/A, not applicable; PO, by mouth.