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LABORATORY UPDATE
prior to the start of surgery and if their use is restricted to less than 24 hours
postoperatively.
Toxic or allergic reactions can occur. Using safe agents for short periods of time can
minimize these.
Cost: use the least expensive effective agent for the shortest period possible. Cost of
antibiotics is negligible compared with cost of prolonged hospitalization due to
infection.
Potential for a false sense of security: meticulous surgery and careful preoperative
and postoperative care are essential in minimizing wound infection.
Which agent?
Cephalosporins are widely favoured.
Reasons include: adequate spectrum of activity, few side effects and a low incidence
of allergic reactions.
First generation agents are more active against S aureus, are less expensive than the
newer agents and have a narrow spectrum of activity (therefore less likely to select
resistant organisms). They are the preferred agents for most surgical prophylaxis (6).
Cefazolin also has a moderately long serum half-life, which is ideal for prophylaxis
(1.8 hours). Data suggest that this agent should be used at a dosage of 2 gram for
an adult patient due to the pharmacokinetics of cefazolin (7).
For colorectal surgery cefoxitin is preferred because of activity against bowel
anaerobes.
Third generation agents should preferably not be used for prophylaxis due to their
limited staphylococcal cover.
B) Which procedures benefit from prophylaxis
Gynaecological surgery
Hysterectomy: Indicated in vaginal hysterectomy, possibly in abdominal
hysterectomy. First generation cephalosporins appear to be as effective as second
or third generation drugs. In the cephalosporin allergic patient clindamycin is an
alternative.
Gram negative bacteria cause wound infection especially when surgery of the
colon, gynaecological organs or genitourinary tract is undertaken.
Abortion: 1st trimester, pen G 2mU or doxycycline 300 mg po, 2nd trimester,
cefazolin 1 gram ivi.
Orthopedics
Simple open fracture: First generation cephalosporin is recommended for
18-24 hours
May 2010
LABORATORY UPDATE
May 2010