Antibiotic Prophylaxis Following Total Joint Replacement

• Routine prophylaxis for dental manipulations using Cephalexin will be instituted for all patients with the following co-morbid diagnoses:

1. Rheumatoid arthritis and systemic lupus
2. Diabetes mellitus
3. Previous joint infection
4. Immunocompromised patients (chemotherapy, or radiation-acquired immunodeficiency disease, or any other diagnosis of immune compromise)
5. Hemophilia
6. Malnutrition

• Patients without the above diagnoses will not receive routine prophylaxis after two years have passed from their joint replacement arthroplasty.
  
  
• Antibiotic prophylaxis will be instituted with two grams of Cephalexin oral one hour prior to dental procedures, with one gram Cephalexin oral given 6 hours later.  In the event of previous Penicillin anaphylaxis or Cephalexin allergy, we will use Erythromycin in the same dosages.
  
  
• This policy is directed specifically at dental procedure prophylaxis and is intended for patients with hip, knee, shoulder and elbow replacement arthroplasty.  Prophylaxis for other procedures (GI-colonoscopy; GU-cystoscopy; Dermatology-skin biopsy; etc.) are at the judgment of the physician performing the procedure.  Typically, if the physician would give antibiotics to protect an artificial heart valve, then the orthopaedic device should also be similarly covered prophylactically.
  
  
• Focal infections elsewhere should be treated with appropriate wound management and/or antibiotics to prevent septicemia that may result in metastatic infection of prosthetic joint replacements.