- See:
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Antibiotic Menu
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Osteomyelitis
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American Dental Association
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AAOS Advisory Statement: Antibiotic Prophylaxis for Dental Patients with Total Joint Replacements
- Perioperative Prophylactic Antibiotics:
- it is essential that antibiotics be given prior to incision;
- in most cases, patients should receive 1-2 gm of IV Ancef 30 min prior to the incision;
- management of "penicillin allergy" (see anaphylaxsis)
- need to distinguish between nonimmune-mediated drug reactions and immune-mediated reactions;
- need to distinguish an immediate IgE-mediated rxn (anaphylaxis) from delayed rxn that is mediated by T cells, immune complexes, and/or antibodies;
- if patient has non-systemic signs of penicillin allergy, then ancef can usually be given safely;
- if there is a history of a severe penicillin allergy (ie, hypotension, difficulty breathing) then alternative medication such as clindamycin should be used;
- remember that it is unfair to label a patient as "penicillin allergic" when the history is equivocal;
- furthermore, theoretically the OR is the safest place to manage an anaphylactic reaction should one occur;
- references:
- Antibiotic Allergy
- Cephalosporin Allergy
- Reduction of vancomycin use in orthopedic patients with a history of antibiotic allergy.
- need to redose intraoperative antibiotics:
- proper dosing and redosing is essential to maintain a serum level to MIC (mean inhibitory concentration) of 8 to 1;
- Total Joint Replacements: - Need for Future Prophylactic Antibiotics;
- the indication for prophylactic antibiotics for total joint patients undergoing dental and endoscopic procedures have been debated in the litterature;
- despite the body of evidence which suggests that prophylactic antibiotics are not mandatory, most orthopaedic surgeons can point to at least one or two cases
in which a joint became infected following a late dental or endoscopic procedure;
- noting this information, it seems reasonable that all patients undergoing significant dental or endoscopic procedures should receive prophylactic antibiotics;
- infecting organisms: (from most frequent to least frequent)
- staph aureus, staph epidermidis, pseudomonas, and beta hemolytic streptococci;
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suggested protocol:
- consider tailoring the antibiotic to the type of invasive procedure;
- dental - oropharyngeal procedures:
- transient bacteremia associated with dental manipulation persists for 10 to 30 minutes;
- oral microbial flora are usually
streptococcal (peptostreptococcus) in nature;
- urinary - rectal procedures:
- gram negative organisms will tend to predominate;
- antibiotic choices:
- 3.0 gm of
amoxicillin 1 hour before and 1.5 gm 6 hours after the initial dose;
- alternatively give 500 mg of Keflex;
- if patient is pen allergic,
erythromycin may be given,1 g 1 hour before dental treatment and 500 mg 6 hours after the first dose;
- as an alternative, the patient can receive
clindamycin;
Orginal Articles: The Timing Of Prophylactic Administration Of Antibiotics And The Risk Of Surgical-Wound Infection.
Prophylaxis against infection. Single-dose cefonicid compared with multiple-dose cefamandole.
The use of quantitative bacterial counts in open fractures.
Comparison of isotonic saline, distilled water and boiled water in irrigation of open fractures.
Factors affecting the incidence of postoperative wound infection.
Cephalosporins for prophylaxis in operative repair of femoral fractures. Levels in serum, muscle, and hematoma.
Perioperative cefamandole prophylaxis against infections.
Perioperative antibiotic prophylaxis for prevention of postoperative neurosurgical infections. A randomized clinical trial.
Perioperative antibiotic prophylaxis for prevention of postoperative neurosurgical infections. A randomized clinical trial.
Bone and serum concentrations of five cephalosporin drugs. Relevance to prophylaxis and treatment in orthopedic surgery.
One day versus seven days of preventive antibiotic therapy in orthopedic surgery.
Concentration of antibiotics in normal bone after intravenous injection. ³
Antibiotic prophylaxis in surgery for hip fractures.
Antibiotic prophylaxis in proximal femoral fracture.
Prophylactic antibiotics in amputation of the lower extremity for ischemia. A placebo-controlled, randomized trial of cefoxitin.
Prophylactic antibiotics in simple hand lacerations.
Low-level colonization of hospitalized patients with methicillin-resistant coagulase-negative staphylococci and emergence of the organisms during surgical antimicrobial prophylaxis.
Amoxycillin-clavulanic acid (Augmentin) antibiotic prophylaxis against wound infections in renal failure patients.
Prophylactic antibiotics in trauma.
The influence of route of administration on wound fluid concentration of prophylactic antibiotics.
Prophylactic antibiotics as an adjunct for skin grafting in clean reconstructive surgery following burn injury.
Antimicrobial treatment of minor soft tissue lacerations: a critical review.
A comparison of gentamicin-impregnated polymethylmethacrylate bead implantation to conventional parenteral antibiotic therapy in infected total hip and knee arthroplasty.
Duration of preventive antibiotic administration for open extremity fractures.
Current Concepts Review: Prophylactic Use of Antibiotics for Procedures after Total Joint Replacement.
John M. Deacon, A.J. Pagliaro M.D., S.B. Zelicof M.D. PH.D., H.W. Horowitz M.D. JBJS (Am) Nov 1996, 1755-1770.
Effect of Intraoperative Blood Loss on the Serum Level of Cefazolin in Patients Managed with Total Hip Arthroplasty.
J.J. Meter, D.W. Polly, R.P. Brueckner, J.J. Tenuta, L. Asplund and W.J. Hopkinson MD. JBJS Vol. 78-A. No 8. Aug 1996.
