What Are the Pros and Cons of Antibiotic Prophylaxis for Joint Replacement?

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  • Written By: Madeleine A.
  • Edited By: W. Everett
  • Last Modified Date: 03 August 2018
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The pros and cons of antibiotic prophylaxis for joint replacement include the beneficial prevention of post-operative infection and risk of allergic reaction. The surgeon will determine if the patient will benefit from antibiotic prophylaxis for joint replacement based on a thorough pre-surgical examination and medical history. The administration of antibiotics prior to joint replacement surgery is common and performed on a routine basis.

A condition called bacteremia, or sepsis, also known as blood poisoning, can occur in the post-operative period following joint replacement surgery. Ever since surgeons have incorporated antibiotic prophylaxis for joint replacement surgery, the incidence of bacteremia and other infections have dramatically been reduced. In addition to bacteremia prevention, administering antibiotics prior to joint replacement surgery typically prevents post-operative joint infections.

Although it is generally considered prudent and safe to pre-medicate with antibiotics prior to orthopedic surgery, there are some risks, including allergic reaction and bacterial resistance to the antibiotic. Sometimes, when antibiotics are administered too frequently, or for prolonged periods of time, bacteria may become resistant to them, rendering the antibiotics ineffective.


Symptoms of bacteremia, or sepsis, include fever, fast heart and respiratory rate, and an elevation of white blood cells. This condition can have a poor prognosis if not treated quickly, or prevented with antibiotic prophylaxis prior to joint replacement surgery. Although most patients who undergo orthopedic surgery will not acquire bacteremia, the risk remains. The surgeon will need to weigh the risks and benefits of antibiotic therapy and discuss his findings with the patient.

Another downside of antibiotic prophylaxis for joint replacement includes allergic reaction. Antibiotic-related allergies can range from mild to life threatening. Mild allergic reactions can cause itching, skin rash, and hives. Rarely, a patient can experience a severe reaction from antibiotics that can cause pronounced swelling of the throat, leading to respiratory difficulty. Unless rapid treatment is initiated, the patient may experience respiratory arrest, leading to the cessation of breathing.

Antibiotics can also cause significant diarrhea, which may lead to dehydration. Since antibiotics destroy bacteria, they also destroy "good" bacteria in the gut, leading to stomach cramps and diarrhea. If prolonged, dehydration can occur, which may require the initiation of intravenous fluids and nutrients. Fortunately, after intravenous fluids are administered, dramatic recovery is typically seen.

Occasionally, a joint infection can occur after joint replacement surgery. Symptoms of a joint infection include, pain and swelling at the surgical site, drainage, and possibly fever. In addition, the patient may feel weak, tired, and nauseated. By administering antibiotics prior to an orthopedic surgical procedure, most cases of post-operative joint infection can be averted.


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