Who decides on the need for antibiotic prophylaxis in patients with major arthroplasties requiring dental treatment: is it a joint responsibility?

The role of antibiotic prophylaxis in patients with prosthetic joints who require dental treatment is controversial. A Working Party of the British Society for Antimicrobial Chemotherapy (BSAC) recently suggested that there was no evidence to support the use of antibiotic prophylaxis in these patients. The purpose of this study was to determine how closely these recommendations were being followed by maxillofacial surgeons (MFS), and to see if there was any consensus on the management of these patients between MFS and orthopaedic surgeons (OPS). With the aid of a postal questionnaire, the opinions of 250 consultant MFS and OPS were sought, response rates were 148 (59.2%) and 113 (41.2%), respectively. Of the OPS, 77.7% always recommended the use of antibiotic prophylaxis as opposed to only 29% of MFS. There were also wide differences in opinion with regard to the antibiotic that should be used in these patients, with the majority of OPS suggesting a cephalosporin, although this may not be the most efficacious antibiotic for oral streptococci. We conclude that this important matter seems to be far from satisfactorily resolved and that further cooperation between the specialties is required to produce guidelines for the safe and effective management of this increasing group of patients.