With this blog entry, I am going to try something a bit different. I know that there is a good readership of my posts but, to date, I have been somewhat disappointed in the number of comments and interactions I have received from you, the readers.
The whole idea of this blog is to be interactive. I want to hear others’ thoughts and ideas.
To this end, I would like to start a “What Would You Do?” entry. I will ask a clinical question or two, maybe present a case and ask you for feedback on what you would do in this situation. Give me your thought processes that lead you to your position. Then in a subsequent post, I will review the responses and give you my approach along with any pertinent clinical evidence I have to back it up.
Let’s start with a recent, very well done study on dental procedures and prosthetic joint infections. (I will not give you the reference until the answers come in.) This study may alter the way we look at antibiotic prophylaxis in these situations. Here are the questions/clinical scenarios I have for you.
1. You placed a prosthetic joint into a patient’s foot. Let’s even expand it out since there aren’t as many joints being placed anymore. You placed some hardware into a patient’s foot while doing surgery on that foot. Let’s say the surgery was 18 months ago. The patient calls you because she is going to the dentist for some dental hygiene and to have a crown placed on a tooth. Do you or don’t you recommend antibiotic prophylaxis for this patient before the dental work?
2. A patient comes to see you for the chief complaint of a bunion. You discuss surgical correction. After the patient agrees to have the surgery scheduled, she informs you that she had a prosthetic knee implanted 18 months ago. Do you place the patient on prophylactic antibiotics to prevent a prosthetic joint infection following your foot surgery?
Let me know how you would approach these situations. There are really no right or wrong answers (or maybe there are … it depends on the answers I get). Once I receive some input, I will give you my thoughts on the subject as well as summary of the recent aforementioned study.
Editor’s note: This blog was originally published at http://www.leinfections.com/category/antibiotics/  and has been adapted with permission from Warren Joseph, DPM, FIDSA, and Data Trace Publishing Company. For more information about the Handbook of Lower Extremity Infections, visit www.leinfections.com/  .