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Antibiotic Prophylaxis

- See:
      - 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:

      - ref: Surgical Site Infection After Arthroplasty: Comparative Effectiveness of Prophylactic Antibiotics: Do Surgical Care Improvement Project Guidelines Need to Be Updated?

- Prophylactic Considerations with Future Dental Procedures

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.

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.    

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.

Prophylactic Use of Antibiotics for Procedures after Total Joint Replacement.

Effect of intraoperative blood loss on the serum level of cefazolin in patients managed with total hip arthroplasty. A prospective, controlled study.

Surgical Site Infection After Arthroplasty: Comparative Effectiveness of Prophylactic Antibiotics: Do Surgical Care Improvement Project Guidelines Need to Be Updated?