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 suggest ed that there was no evidence to support the use of antibiotic prophyl axis in these patients. The purpose of this study was to determine how closely these recommendations were being followed by maxillofacial su rgeons (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%), res pectively. Of the OPS, 77.7% always recommended the use of antibiotic prophylaxis as opposed to only 29% of MFS. There were also wide differ ences in opinion with regard to the antibiotic that should be used in these patients, with the majority of OPS suggesting a cephalosporin, a lthough this may not be the most efficacious antibiotic for oral strep tococci. We conclude that this important matter seems to be far from s atisfactorily resolved and that further cooperation between the specia lties is required to produce guidelines for the safe and effective man agement of this increasing group of patients.