- Antibiotic Menu
- Osteomyelitis
- Perioperative Prophylactic Antibiotics:
- the main question we need to ask is what are we trying to accomplish?
- obviously we want a strategy that prevents the infection of MRSA, MSSA, staph epi, and anaerobic infections;
- giving ancef alone, would not prevent MRSA, staph epi, and anaerobic infections;
- hence there must be a strategy such as MRSA screening prior to surgery to prevent infection (unless Vancomycin is routinely
given - which it should not);
- 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
- clindamycin:
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.
Perioperative cefamandole prophylaxis against infections.
One day versus seven days of preventive antibiotic therapy in orthopedic surgery.
Concentration of antibiotics in normal bone after intravenous injection.
Antibiotic prophylaxis in surgery for hip fractures.
Antibiotic prophylaxis in proximal femoral fracture.
Prophylactic antibiotics in simple hand lacerations.
Prophylactic antibiotics in trauma.
The influence of route of administration on wound fluid concentration of prophylactic antibiotics.
Antimicrobial treatment of minor soft tissue lacerations: a critical review.
Duration of preventive antibiotic administration for open extremity fractures.
Prophylactic Use of Antibiotics for Procedures after Total Joint Replacement.