PreOp anitbiotics for knee replacement

[Jacads]

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68 year old female having a total knee but with a history of atrial valve replacement in 2003. is 1 gram Ancef adequate coverage 30 minutes preop or would you reccomend utilizing gentamicin 1.5mg/kg and ampicillin 2.0 grams for coverage even though she is high risk with the valve replacement according to the AHA this is a "clean" operation versus something like the gut. Would you stay just with ancef then start the gent and ampicillin if she started spiking fevers until blood culture sensitivites come back?


Thanks

 

[28657]

A 3rd generation cephalosporin is fine pre-op coverage.

 

[Jacads]

So you would choose a third generation over the first generation?

Thanks

A 3rd generation cephalosporin is fine pre-op coverage.

 

[28657]

Ooops meant to type 1st generation. Any 1st or 2nd generation ceph would be fine....I think.

 

[ButlerPharm.D.]

No trailing zeros...bad bad bad....2 not 2.0!

 

[sdn1977]

Its been awhile since I checked the recommendations, but last I looked it was cefazolin 1 g 30min (or other contracted first generation cephalosporin) before incision & q8h x 2 more doses. If documented pcn or ceph allergy, use vancomycin. If you have reason to suspect infection, draw c&s & cover with vancomycin & aminoglycoside until results. The recommendations I think have been altered since the last major revision, so I apologize if this is off.

 

[DrPharm]

Cefazolin is DOC for pre-op.....and if the patient is allergic to Penn & Cef, give them Vancomycin 1gm infused over 1 hour 120 mins before 1st incision