Guidelines
Choice of Prophylactic Antibiotic

Choice of Prophylactic Antibiotic

Choice of Prophylactic Antimicrobial

Antimicrobial prophylaxis is generally unnecessary for “clean” surgical procedures

For the majority of surgical procedures in which antimicrobial prophylaxis is indicated, a single dose of ceFAZolin 2 g IV given within the 60 minutes before the first surgical incision is appropriate

Beta-lactam Allergy

  • Approximately 10% of the population report having a penicillin allergy; however, greater then 90% of these individuals are not truly allergic
  • Non-beta-lactam options may be more toxic and less effective
  • For example, there is an increasing rate of gram-positive resistance to clindamycin. In addition, a study by Blumenthal et al. found that patients with a reported pencillin allergy had a 51% increased risk of surgical site infection that was primarily related to receiving a non-beta-lactam antibiotic
  • For immediate or Type 1 (IgE-mediated) hypersensitivity reactions (e.g. anaphylaxis, urticaria, angioedema, hypotension, bronchospasm, stridor, pruritus), cross-reactivity between cephalosporins and penicillins is due to similarity in side-chains and was overestimated in the past. There is only significant risk of cross-reactivity among penicillins and between penicillins and cephalosporins with similar side-chains
  • Immediate or Type 1 (IgE-mediated) hypersensitivity reaction to penicillin warrants the avoidance of cephalosporins with similar side chains and other penicillins
  • Cross-reactivity among cephalosporins is low due to heterogeneity among side chains. Cephalosporin allergic patients may safely receive another cephalosporin with dissimilar side chains
  • CeFAZolin is the only systemic beta-lactam included in this guide and may safely be given to patients with immediate or Type 1 (IgE-mediated) hypersensitivity reactions to penicillins or other cephalosporins
  • It should only be avoided in patients allergic to ceFAZolin or who have a severe non-IgE mediated reaction to a beta-lactam antibiotic (see below)

Severe non-IgE mediated hypersensitivity reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms, immune hepatitis, hemolytic anemia, serum sickness, interstitial nephritis, small vessel vasculitis)- warrant the avoidance of all beta-lactams

Idiopathic reactions are not clearly immune-mediated (non-pruritic morbilliform rash) and are not a contraindication to taking a different beta-lactam such as ceFAZolin

More Information

For more information on assessing beta-lactam allergies, please see the:

Known MRSA Colonization

  • Consider administration of pre-op vancomycin prophylaxis in addition to recommended routine surgical prophylaxis regimen
  • Vancomycin ALONE is less effective than ceFAZolin for preventing surgical site infections due to MSSA

Consider pre-procedural MRSA decolonization

Consider consult to infectious diseases/medical microbiology for recommendations