Prophylaxis with oral cefadroxil versus intravenous cefuroxime in trochanteric fracture surgery

Abstract

A prospective, randomized study was performed in 559 patients to compare two doses of oral cefadroxil with three doses of intravenous cefuorxime as antibiotic prophylaxis in intra- and subtrochanteric hip fracture surgery. Antibiotic concentrations in the wound fluid were determined at the start and at the end of the operation. The first dose of cefadroxil was given about 2 h before surgery and cefuroxime about 30 min before operation. In 226/242 (93%) patients randomized to oral cefadroxil, the concentration in the wound during surgery was on average 15 micrograms/ml, i.e., well above the minimum inhibitory concentration (MIC-90) for Staphylococcus aureus. In the cefuroxime group, antibiotic levels in the wound exceeded the MIC-90 for S. aureus in 204/210 (97%) of the patients at the start and/or at the end of surgery. All patients were followed up for 4 months. One deep and five superficial infections occurred in the cefuroxime group and no deep but one superficial infection in the cefadroxil group (P = 0.07). S. aureus was cultured in three of the infected cases while cultures were negative in four patients. Four of the seven infected patients had adequate levels of antibiotic in the wound during surgery, and in three patients no antibiotic assay was performed. The infected patients did not differ in age, sex, operation time, bleeding or any other basic variable compared with patients who healed without complications. Two doses of cefadroxil seems to be practical and as effective as intravenously administered cefuroxime as antibiotic prophylaxis in trochanteric hip fracture surgery.

Prevention of Surgical Site Infection After Open Prosthetic Inguinal Hernia Repair: Efficacy of Parenteral Versus Oral Prophylaxis with Amoxicillin‐Clavulanic Acid in a Randomized Clinical Trial

“…Investigations from various surgeries have demonstrated that oral antibiotic prophylaxis is effective for preventing infectious complications [15,16,[36][37][38]. Moreover, the oral route of prophylaxis is likely to be more appropriate for day-case hernia repair.…”

O impacto de mudanças nas medidas de prevenção e no tratamento de infecções incisionais em cirurgia de revascularização do miocárdio

“…The empirically selected antibiotic agent was cephadroxil as it has a better range compared to cephalexin, with a better action against strains of Staphylococcus and Streptococcus, as well as exhibiting a good penetration into bone tissue [21]. Specific antibiotic therapy, on the other hand, is limited to subsequent stages, according to the results of cultures.…”

<![CDATA[The impact of new preventive measures and treatment of surgical site infections after coronary artery bypass graft surgery]]>

“…Even though, in our service, daily assessment of surgical wounds was already routinely performed, the new protocol established a stricter sampling of wound secretions for culturing and an earlier start to antibiotic therapy. The empirically selected antibiotic agent was cephadroxil as it has a better range compared to cephalexin, with a better action against strains of Staphylococcus and Streptococcus, as well as exhibiting a good penetration into bone tissue [21]. Specific antibiotic therapy, on the other hand, is limited to subsequent stages, according to the results of cultures.…”