If the patient is an adult who is able to take oral medication and is not allergic to penicillin, then the procedure recommendations are to take 2 g amoxicillin. The information within one of the scenarios asks whether the patient is allergic or not to penicillin or ampicillin, whether the patient is able or unable to take oral medication, and whether the patient is an adult or child. Among those on the list is “Management of patients with orthopedic implants undergoing dental procedures.” To date, the AAOS has generated a list of 13 orthopedic conditions for which AUC have been established. It enabled the clinician to decide on the appropriateness of various treatments in a set of hypothetical, but clinically realistic patient scenarios. The AAOS began developing Appropriate Use Criteria in 2011 as a tool to implement evidence-based clinical practice guidelines. The AAOS website details the updated AUC in an article titled “AAOS Board Approves AUC on Antibiotic Use for Dental Procedures,” authored by Terry Stanton and Sheryl Cash. AUC are provided to indicate when it may be appropriate to consider antibiotic administration prior to dental procedures and to recommend which antibiotic to use in patients with joint replacements. This is based on new criteria referred to as “appropriate use criteria” (AUC). More recently, however, the AAOS is now recommending a cephalosporin rather than clindamycin in penicillin-allergic patients. It has always been accepted that cephalosporins had significant enough incidence of cross-allergenicity with penicillin to warrant the recommendation of clindamycin instead of a cephalosporin in those individuals. In penicillin-allergic patients, clindamycin has historically been the recommended optional drug because it is believed to have little or no cross-allergenicity with penicillin. These individuals are usually immunocompromised and the standard antibiotic of choice is amoxicillin. The American Academy of Orthopedic Surgeons (AAOS) has historically recommended antibiotic premedication in select patients with hip or knee implants undergoing medical or dental procedures that produce bacteremia.
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