Peri-operative Antibiotics question

[pharmdguy18]

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Hello all, I have a question I'm not sure about the answer or where to post on the forum.

Patient is going to have knee replacement and has penicillin allergy, although he is stable on cephalexin. What would be the best antibiotic to use peri-operatively? Choice of antibiotics: cefazolin, vancomycin, clindamycin. I was thinking cefazolin because it's a 1st gen like cephalexin, but a friend argued for vancomycin. What do you guys think?

 

[WorthlessOxygen]

Assuming no history of MRSA my knee jerk response would be cefazolin since the patient apparently tolerates cephalosporins.

I was taught to favor other options over vanco due to potential hypotension. But I'm just a retail schmuck so [emoji2369]

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[lane one]

Ancef. Only would go with vanc or clinda if its a true anaphylaxis to beta-lactams. Which in this case, we know cephalosporins are fine so ancef it is.

 

[Xarelto-10]

Ancef. Only would go with vanc or clinda if its a true anaphylaxis to beta-lactams. Which in this case, we know cephalosporins are fine so ancef it is.

ditto

 

[dpmd]

Ancef ought to be fine but the bigger question is what do you mean they are stable on keflex? I wouldn't be in a hurry to put a foreign body into someone currently being treated for an infection.

 

[El Trombopag]

Typically our orthos will go cefazolin alone in a scenario like that, and ADD preop vancomycin if they were MRSA positive or had a history of MRSA infection

Seems to be backed by Sanford:

 

[pharmdguy18]

Thanks guys! The question didn't mention anything about MRSA and didn't state that the PCN allergy was due to anaphylaxis. Figured it should still be Ancef due to the big tip about patient being "stable on cephalexin in the past."

 

[Jaundice101]

Cefazolin for sure unless high risk for MRSA in which case cefazolin and vancomycin as there is published data that vancomycin alone leads to greater rates of MSSA SSI. Clinda ain't so good in most places due to increasing rates of resistance in both MSSA and MRSA.

Bull AL, Worth LJ, Richards MJ. Impact of vancomycin surgical antibiotic prophylaxis on the development of methicillin-sensitive staphylococcus aureus surgical site infections: report from Australian Surveillance Data (VICNISS). Ann Surg. 2012 Dec;256(6):1089-92.