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Antibiotics after joint replacement

Patient Education
Published Jan. 25, 2019
• Reviewed by a UI Health Care Provider
on Oct. 1, 2018

Total joint replacement parts are made of artificial materials. After your surgery you need to take an antibiotic before certain appointments or tests.

You may need an antibiotic

  • Before going to the dentist
  • Before procedures that look at your bladder or colon, such as cystoscopy, colonoscopy, and sigmoidoscopy
  • Before surgeries that may let bacteria into your blood stream, such as lower urinary tract or bowel surgeries
  • If you have a bacterial infection on your skin (a boil) or pneumonia

Below is a list of the antibiotics that should be used. Please show this to your dentist and other doctors.

ProcedureAntibioticDoseWhen to take
Dental (teeth, mouth)
  • Cephalexin, Cephradine, Amoxicillin
  • If you are allergic to the above medicines, take Clindamycin.
  • 2 grams by mouth
  • 600 mg by mouth
one-time dose, one hour before the procedure
Ophthalmic (eye)Gentamicin, tobramycin, ciprofloxacin, gatifloxacin, levofloxacin, moxifloxacin, ofloxacin, or meomycingramicidin-polymyxin Bcefazolin
  • Use drops topically for two to 24 hours
  • 100 mg subconjunctival
Talk with an ophthalmologist or pharmacist for dosing.
Orthopedic
  • Cefazolin
  • Cefuroxime
  • Vancomycin
  • 1 to 2 grams IV
  • 1.5 grams IV
  • 1 gram IV
Start the dose 60 minutes before the procedure.
Vascular
  • Cefazolin
  • Vancomycin
  • 1 to 2 grams IV
  • 1 gram IV
Start the dose 60 minutes before the procedure.

Gastrointestinal

  • Esophageal, gastroduodenal, biliary tract
  • Colorectal
  • Cefazolin
  • Neomycin and Erythromycin base or Metronidazole
  • 1 to 2 grams IV
  • 1 gram by mouth
  • Start the dose 60 minutes before the procedure.
  • Talk with a GI doctor or pharmacist about when to start it.
Head and neck
  • Clindamycin
  • Gentamicin
  • Cefazonlin
  • 600-900 mg IV
  • 1.5 mg/kg IV
  • 1 to 2 grams IV
Start the dose 60 minutes before the procedure.
Obstetrics
  • Cefoxtin, Cefazolin
  • Ampicillin/Sulbactam
  • 1 to 2 grams IV
  • 3 grams IV
Start the dose 60 minutes before the procedure.
GenitourinaryCiprofloxacin500 mg by mouth or 400 mg IVStart the dose 60 minutes before the procedure.

If a tourniquet is used, be sure all the antibiotic has infused before inflating it. Guidelines are based on the American Academy of Orthopedic Surgeons and the American Dental Association recommendations from May 2009.