Antibiotic prophylaxis needs to be addressed in patients at risk for infective endocarditis and artificial joint replacement infection.
Antibiotic prophylaxis is recommended when operating on mucosal or infected skin and when performing flaps or grafts in patients with risk factors for endocarditis. It is also recommended when operating on mucosal surfaces, infected skin, non-infected high risk areas (lip, ears, nose, groin, legs), and when performing flaps or grafts in patients with a total joint replacement.
As this surgical procedure is not in a high risk area and will not require a flap or graft to repair, no prophylaxis is needed.
Antibiotic prophylaxis in dermatological surgery is recommended for the following patients: (
Wright et al. J Am Acad Dermatol 2008)
High-risk cardiac conditions (infected skin or breach of oral mucosa):
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Prosthetic heart valve
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History of infectious endocarditis
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Unrepaired cyanotic congenital heart defect
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Repaired congenital heart defect with prosthetic materials or devices
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Repaired congenital heart defect with residual defects at site of prosthetic patch or device
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Cardiac transplant recipient with cardiac valvulopathy
Total joint replacements (infected skin, breach of oral mucosa, or non-infected high risk surgical sites including lip, ear, nose, groin, legs, flaps, grafts):
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First 2 years after joint replacement
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Previous prosthetic joint infection
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Type I diabetes mellitus
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Immunosuppression or malignancy
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Malnourishment
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Hemophilia
The recommended oral prophylactic antibiotics in patients at risk of infective endocarditis and/or prosthetic joint infection are as follows (note, IV antibiotics can be used as well):
Non-oral wedge excisions of lip, ear, nasal flaps, all grafts:
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Cephalexin or dicloxacillin 2 g PO x 1
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If allergic to penicillin: clindamycin 600 mg PO x 1 or azithromycin 500 mg PO x 1 or clarithromycin 500 mg PO x 1
Oral mucosa breached:
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Amoxicillin 2 g PO x 1
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If allergic to penicillin: clindamycin 600 mg PO x 1 or azithromycin 500 mg PO x 1 or clarithromycin 500 mg PO x 1
Lesions in the groin or on the legs:
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Cephalexin 2 g PO x 1 or double-strength trimethoprim-sulfamethoxazole 1 tablet PO
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If allergic to penicillin: clindamycin 600 mg PO x 1
Clinical Pearl: Antibiotic prophylaxis is recommended when operating on mucosal or infected skin and when performing flaps or grafts in patients with risk factors for endocarditis. Antibiotic prophylaxis is recommended when operating on mucosal surfaces, infected skin, non-infected high risk areas (lip, ears, nose, groin, legs), and when performing flaps or grafts in patients with a total joint replacement within the last 2-year or those with joint infection risk factors.
