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Antibiotic prophylaxis for Dental Patients with Joint Prostheses? A Decision Analysis

Published online by Cambridge University Press:  10 March 2009

Jed J Jacobson ,
Stuart Schweitzer ,
David J. DePorter  and
J. Jack Lee
Jed J Jacobson
Affiliation:
The University of Michigan School of Dentistry
Stuart Schweitzer
Affiliation:
UCLA School of Public Health
David J. DePorter
Affiliation:
UCLA School of Dentistry
J. Jack Lee
Affiliation:
UCLA Center for Health Sciences
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Abstract

A decision analysis was performed to assess the risks, costs, and effects of no prophylaxis, oral penicillin, and cephalexin regimens currently being debated for dental patients at risk for late prosthetic joint infection (LPJI). The analysis suggests that there is a very small risk of LPJI (29.3 cases per 106 dental visits), which is outweighed by a greater risk of death with an oral penicillin strategy than with a “no prophylaxis” strategy (2.31:1.93). An oral cephalosporin appears to spare life and limb but does so at an extremely high cost. Over $500,000 must be spent to spare one year of life, while $480,000 needs to be spent to prevent one case of LPJI. Some individual dental patients may still be at a much greater risk for LPJI than others. However, from the evidence to date, routine predental antibiotic prophylaxis for all prosthetic joint patients is a very expensive preventive strategy and is not cost-effective. However, clinical experience suggests that antibiotic prophylaxis may be appropriate in some situations.

Type
Special Section: Assessing the Technology of Dentistry, Part II
Information
International Journal of Technology Assessment in Health Care , Volume 6 , Issue 4 , October 1990 , pp. 569 - 587
Copyright
Copyright © Cambridge University Press 1990

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