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I am extremely allergic to penicillin but the doctor wants me to take antibiotics after my total knee replacement next week. I'm in good health. They are using small incisions to cut the knee open because the operation is arthroscopic. Could I skip the antibiotics?

The routine use of antibiotics to prevent infection after arthroscopic surgery remains a highly debated topic. The American Academy of Orthopaedic Surgeons (AAOS) has not put out an advisory statement yet. They say there's not enough evidence for or against an antibiotic policy.

Health experts are concerned about the cost of routine or prophylactic use of antibiotics to prevent infection. They say it's expensive and the risk of infection with arthroscopic surgery is low anyway. There's also plenty of data to show that overuse of antibiotics has led to bacteria that are resistant to these drugs. That means when someone does get an infection, the antibiotic may not help.

There are other drugs that can be used besides penicillin. Talk to your doctor and your pharmacist. Find out what might work best for you. It is certainly possible to request 'no prophylactic antibiotics.' It's likely you'll have to sign a form to show this was your choice against your doctor's best advice.

If you have diabetes, immune system problems, or any skin disorders, then you may want to rethink your decision. Your doctor will check you for any other risk factors that could increase your risk of infection. You wouldn't want to go to the time, trouble, and expense of a joint replacement only to lose the implant to infection later.

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