Types of Prophylaxis in Medicine

The term prophylaxis means preventative, or to prevent. Greek in origin, from the word "phylax", meaning "to guard" and "watching", prophylactic treatment is frequently used in healthcare to minimize illness and disease.

In medicine, the term prophylactic is used to describe surgeries, dental cleanings, vaccines, birth control and many other types of procedures and treatments that prevent something from happening. A prophylactic hepatitis vaccine prevents the patient from getting hepatitis, while a prophylactic dental cleaning prevents tooth decay.

Prophylaxis is a good thing in health care, it prevents an unintended problem by addressing the potential issue before it actually becomes problematic. The prevention of harm or disease is often far easier, faster, and less expensive and less painful than treating the disease when it is allowed to occur.

Preventative care takes many forms and continues even after a disease process has been identified. Generally speaking, prophylaxis doesn't just mean preventing disease, it can also mean preventing a worsening of disease, minimizing the severity of disease, and preventing over-treatment.

Primary Prophylaxis: Preventing or increasing resistance to disease that has not occurred. This may include routine medical checkups and vaccinations. Pap smears, screening colonoscopies, and mammograms are often done as primary prophylaxis when the patient is well and there are no signs of disease. Once a disease is known to be present, screening is no longer considered primary prophylaxis.

Secondary Prophylaxis: Measures that are taken to prevent the recurrence of a medical problem or injury that has already occurred, such as changing the work environment to prevent re-injury or taking a statin to prevent recurrent heart attack.

Tertiary Prophylaxis: Measures taken to reduce the impact of a chronic, ongoing disease or injury that is likely to produce long-lasting effects, such as stroke rehab programs or disease management programs for heart failure.

Quaternary Prophylaxis: This is the idea that excessive medical treatment should be prevented, and that patients who will not benefit from further medical treatment should not be subjected to it. For example, if a patient does not respond to a first round of chemotherapy, there is no logical reason to do a second round of chemotherapy with the same medication.

In general conversation, the term prophylactic is often a synonym for condoms, as they are considered a prevention for unwanted pregnancy.

The term "prophylactic antibiotics" refers to antibiotics that are given to prevent infection rather than treat infection. Prophylactic antibiotics are avoided whenever possible in healthcare, as the overuse of antibiotics has led to antibiotic resistance, and provides no benefit to the patient. There may be individual instances where the use of antibiotics prior to surgery is deemed to be appropriate, or when a patient is sick enough to warrant the use of antibiotics before blood cultures or other lab results confirm the presence of infection. In these cases, the potential benefit outweighs the risk of harm, and the physician chooses to utilize antibiotics.

That said, there are a few limited times when preventative antibiotics are known to be useful to the vast majority of patients and research supports the use of these medications to prevent harm. Almost every patient undergoing surgery that involves an incision in the skin will receive prophylactic antibiotics within 30 minutes of the skin incision, and have it re-administered every 4 hours or if there is a large amount or blood loss. This applies to dental procedures as well, which carry a specific risk of spreading infection to the heart, in particular, the hearts of individuals that have (or had) serious heart problems.

Prior to a dental procedure, individuals who have a history of infective endocarditis, a serious heart infection, should have antibiotics. The same is true of individuals who have had a cardiac transplant with valve problems, people who have had their heart valve replaced and specific types of heart defects that are present at birth.

There is no longer a recommendation that individuals with joint replacements receive antibiotic prophylaxis prior to dental procedures. If you have had a procedure that makes prophylactic antibiotics a good idea, your surgeon will make you aware of this. Typically, the dentist will also ask questions to determine if this is necessary as well, in case you forget to mention it.