Antibiotic for dental procedures questioned

Here’s a case study that blows a massive hole in the argument that antibiotic treatment before dental procedures isn’t cost-effective.

The Beth Israel Hospital in Boston reports that a 78-year-old woman who had undergone successful finger-joint replacement surgery several years before reported to the dentist for a root canal. She was not pre-treated with antibiotics. A day after the root canal, she developed signs of local inflammation in the hand, including lymphanginitis creeping up her forearm.

At the hospital, doctors administered a 48-hour course of intravenous penicillin and first-generation cephalosporins. She seemed to recover and was discharged on an eight-day regimen of oral Augmentin.

Within days she relapsed; this time even cellulitis was present. She was wheeled into the operating room where surgeons removed the silicone implant and debrided the wound. After surgery, she required whirlpool treatments to bring the hand back to normal.

Cultures of the debrided material grew Propionibacterium, an anaerobic pathogen commonly found in the oral cavity along with Streptococcus viridans, Peptostreptococcus, and Staphylococcus aureus. Beth Israel doctors concluded that a sudden rush of pathogens from the oral cavity into the bloodstream was probably responsible for this patient’s serious infection. Their recommendation: Consider antibiotic pre-treatment for patients with implants, regardless of how seemingly small or isolated the prosthetic is.

The cost of antibiotic pre-treatment in this patient would’ve run about $10. Seems worth it now, doesn’t it?

Reference

Skoll HD. Late infection of hand implant after a dental procedure. Am J Orthop 1997; February:145-146.