· Aims x 6
· Practical considerations x 7
|
Aim |
Cefazolin for joint replacement surgery |
|
Indicated (i.e. not in all surgery at clean sites) |
· Moderate risk · Severe morbidity · Use of implant |
|
Bactericidal preferably |
· Yes |
|
Penetrates the relevant tissues |
· Good for skin, bone, joint |
|
Targets the relevant microbes |
· First generation cephalosporins effective against skin commensal gram positive cocci · (Note gram negative rods common in hospitalized patients) |
|
Low risk of encountering antimicrobial resistance |
· Low risk if from community · But ineffective against MRSA, use vancomycin instead if in hospital several days |
|
Low risk of promoting microbial resistance |
· Minimal necessary duration: 24 hours total · Minimal necessary spectrum: i.e. not piperacillin/tazobactam |
|
Consideration |
Cefazolin for joint replacement surgery |
|
Dose |
· 25mg/kg pre-induction |
|
Route |
· IV ideal |
|
Rapid onset |
· Ideally 30-60 mins pre-incision, to allow penetration of skin · MUST be well before tourniquet if knee replacement |
|
Long duration: ensure cover during long procedure |
· Repeat at 4 hours if surgery ongoing · Repeat at 8 hours post-op |
|
Adjustment in organ dysfunction |
· Cefazolin is renally cleared. ↓ frequency if CrCl reduced esp <30mL/min |
|
Side effects |
· High therapeutic index · Risk of anaphylaxis |
|
Cost |
· Cheap |