Antibiotics before Surgery?
The guidelines for taking antibiotics prior to dental or surgical procedures in the mouth have changed many times over the last 20 years. Dental or surgical procedures in the mouth can create a mild bacteremia (bacteria in the blood stream) for several hours after the treatment. The concern was that these bacteria in the blood would attach themselves to areas of the body, multiply and create a larger infection. Areas of the body with prosthetic parts including hip and knee replacements, prosthetic heart valves or other parts were thought to be most at risk for bacterial attachment and infection. Patients with congenital heart defects repaired or unrepaired are also at risk. Recent studies have shown that the risk of infection from dental surgery is much lower than once thought. The adverse effects of taking oral antibiotics is now an important consideration due to the increasing number of antibiotic resistant infections. For the aforementioned reasons antibiotic prophylaxis is now limited to only a few specific cases. The American Heart Association(AHA) Guidelines for Antibiotic Prophylaxis were updated in 2017.
The following are the only cases for which the AHA recommends antibiotics prior to a dental or surgical procedure:
1. Prosthetic cardiac valves
2. Prosthetic material used for cardiac valve repair, such as annuloplasty rings and chords.
3. Previous heart infection.
4. Unrepaired cyanotic congenital heart disease or repaired congenital heart disease, with residual shunts or valvular regurgitation at the site of or adjacent to the site of a prosthetic patch or prosthetic device.
5. Cardiac transplant with valve regurgitation due to a structurally abnormal valve.
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Importantly, Mitral valve prolapse is no longer a reason to receive oral antibiotics prior to surgery. Many patients are still receiving antibiotics erroneously and should be made aware of the current guidelines.
Antibiotics for the prevention of prothetic joint infection is a little more controversial. Many orthopedic surgeons request that their patients receive antibiotics for up to two years after surgery. In cases where patients have had a previous joint infection the surgeon may recommend antibiotics for a longer period of time. Recently the Canadian Dental Association in conjunction with the Canadian Orthopedic association published this consensus statement.
If you are a patient and unsure if you should continue to take antibiotics prior to your dental or surgical procedures speak to your health care provider about the current guidelines and recommendations.