NEW PERSPECTIVES IN ANTIBIOTIC-PROPHYLAXIS

Prophylaxis in surgery : There has been much debate over the choice of antibiotics duration of treatment and routes of administration for an tibiotic prophylaxis in surgery patients. Several new strategies have been proposed on the basis of pharmacological features; early experien ce has been reported. New strategies in orthopedics : local injection of 750 mg cefuroxime in the limb undergoing surgery has resulted in lo cal concentrations reaching up to 133 to 88 mg/kg in bone and fat tiss ues respectively, ie. much higher levels than those achieved by system ic injection. In prostheses, the use of acrylic material incorporating antibiotics such as vancomycin may prevent staphylococcal infection; other antibiotic classes, quinolones, aminoglycosides (tobramycin in c ombination with vancomycin) have also been used successfully Metallic implants coated with antibiotic, for instance fluoroquinolones, have p revented the first stage of bacterial colonization in orthopedic surge ry by inhibiting bacterial adhesion on foreign material, as was confir med in in vitro and in vivo experiments. Cardiovascular surgery : Ther e has been a tendency to replace second generation cephalosporins by v ancomycin. This offers a spectrum and pharmacokinetics which fit bette r with the risk of staphylococcal infections with a single dose of 10 to 20 mg/kg, results have been more favorable with vancomycin. Digesti ve surgery : A recent fluoroquinolone, trovafloxacin, with a spectrum including anaerobes, is a useful antibiotic for prophylaxis in colorec tal surgery, but other quinolones could be effective in other surgical situations with an advantage in terms of cost. Improved prevention : These recent updates in antibiotic prophylaxis strategies have shown t hat new procedures and new strategies may contribute to improvement in the prevention of surgical infections.