Professional Documents
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Introduction:
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Antibiotic Prophylaxis:
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Antibiotic
Surgery:
prophylaxis
in
Joint
Replacement
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Local administration:
Vancomycin and tobramycin are the most commonly
chosen antimicrobial agents for local use in open
fractures, but other agents, such as colistin, have begun
to be investigated for this because of concern about drug
resistance. Also it is noteworthy that both clindamycin and
trimethoprim-sulfamethoxazole are efficacious in treating
many strains of MRSA, and their use in a prophylactic
capacity may obviate the complication of prophylactic
use of vancomycin. It should aiso be remembered that
vancomycin is bacteriostatic, whereas cephalosporins
and aminoglycosides are bactericidal. For this reason
the independent use of vancomycin should be avoided
for prophylaxisin open fractures with colonized wounds.
Likewise, antibiotic impregnated cement beads are the
most commonly used source of antibiotic agents in the
management of open fractures. However, this method
requires a second surgical procedure to remove the beads.
Ostermann et al demonstrated that the additional use of
local aminoglycoside impregnated polymethylmethacrylate
(PMMA) beads significantly reduced the overall infection
rate to 3.7%, compared with 12% when only i.v. antibiotics
were used (only for the treatment of type III open
fractures). The advantages of the bead pouch technique
include: high local concentration of antibiotics, often 10 to
20 times higher than concentration provided by systemic
administration, a low systemic concentration, which
protects from the adverse effects of aminoglycosides, a
decreased need for the use of systemic aminoglycosides
sealing of the wound from the external environment
with film dressing [13]. Other methods currently being
investigated for providing local antibiotic prophylaxis
in open fractures include vancomycin powder sprinkled
below the fascia before wound closure, which has been
reported in a series of patients with spinal trauma, and
implants covered with an antibiotic impregnated coating
or sleeve [29, 30]. To our knowledge currently, no results
of any prospective comparative trials of such methods are
available. However, high dose local antibiotic delivery is
likely to become more common in the future prevention
and treatment of infections.
Conclusion:
The antibiotics are a very important adjuvant treatment
in the ostheoarticular pathology. The antibiotic treatment
cannot replace the simple surgical discipline and asepsis
References:
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3. Drancourt M, Stein A, Argenson JN Oral rifampin
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4. Gristina AG, Costerton JW Bacterial adherence to
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5. Anthony G Biomaterial-centered infection (Microbial
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8. Gillespie WJ, Walenkamp GH: Antibiotic prophylaxis
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