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The Correct Answer is C!

Knowledge to Practice, in collaboration with Mayo Clinic, offers online board review and lifelong learning products in Internal Medicine. With a full pre-assessment, you can identify the topics you’ve mastered and focus your time on topics where you need it the most. Our products have been shown to increase knowledge 75% more than traditional methods in less time.1

Question:

A 65 year-old man is awaiting dental examination with a possible dental extraction. His history is noteworthy for coronary artery disease, hypertension, osteoarthritis, and total knee arthroplasty performed 3 years ago. He has no known drug allergies. Physical examination is unremarkable apart from well healed scar of the left knee. 

Which of the following is the best choice for prevention of prosthetic joint infection in this patient?

  1. Doxycycline
  2. Clindamycin
  3. No prophylaxis is needed
  4. Amoxicillin

Rationale:

In the most recent joint American Academy of Orthopedic Surgeons and American Dental Association clinical practice guidelines, routine prophylactic antibiotics in patients with prosthetic joints are not recommended. There has been no evidence to support that prophylactic antibiotics reduces the risk for prosthetic joint infection after a dental procedure. Antibiotic prophylaxis has been shown to decrease incidence of post-procedure bacteremia, but there is no evidence that bacteremia leads to increased incidence of prosthetic joint infection. Some have suggested that patients undergoing “high risk” procedures be considered for prophylaxis if they have had a joint replacement within two years, are immunocompromised, or have comorbidities such as prior prosthetic joint infection, HIV infection, diabetes, malnourishment, malignancy, or hemophilia. However, the evidence to support these recommendations is still unclear. The patient in this case does not have the mentioned risk factors and had his joint replacement more than 2 years ago, so antibiotics are not indicated.

1.  Source: "Comparative Analysis of Pre/Post Assessments of Live/Didactic Course Attendees when compared to Mico-Learning/Online Course Users., "Knowledge to Practice, 2017.

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