6. Understand your patient’s penicillin allergy
Cephalosporins typically are safe in patients with a penicillin allergy unless a history of anaphylaxis
is documented
Campagna JD, Bond MC, Schabelman E, Hayes BD. The use of cephalosporins in penicillin-allergic patients: a literature review. J Emerg Med. 2011 Jul 8. [Epub ahead of print]
The rate of cross-reactivity may be as low as 1% between the two classes of drugs, and second- and third-generation cephalosporins have negligible risk due to substantial chemical structural differences from penicillins. Consider cefoxitin in these patients in place of cefazolin.
7. No infection? No antibiotics.
Stop antibiotics after the operating room unless infection is present
Van Eyk N, van Schalkwyk J. Antibiotic prophylaxis in gynaecologic procedures. J Obstet Gynaecol Can. 2012;34(4):382–391.
There are no data to support additional dosing after the operating room, even for 24 hours, to prevent infection. Hospitals and accrediting bodies are examining overuse of antibiotics, including extending prophylactic antibiotics outside the operating room, and surgeons can be cited for this practice.
8. Enourage open disclosure
Communicate with your residents/fellows and anesthesia team about antibiotic choice,
dose, and redosing
Altpeter T, Luckhardt K, Lewis JN, Harken AH, Polk HC Jr. Expanded surgical time out: a key to real-time data collection and quality improvement. J Am Coll Surg. 2007;204(4):527–532.
Discuss the length of the procedure and the time required for the antibiotic to take effect. Make sure that the antibiotic(s) you’ve ordered actually are what is being given and resolve any differences of opinion by consensus. This is often done during a “time out” but may need to be done earlier depending on when antibiotics are started.
9. Know the rules
Become familiar with hospital, state, and other local policies about antibiotic use
To reduce antimicrobial resistance, many hospitals have restrictions on the use of some medications, such as vancomycin. Vancomycin is not recommended for antibiotic prophylaxis for any gynecologic procedure; alternative agents should be chosen. Clinicians can be cited for use of a restricted medication when the use of other agents is possible. Understand if postoperative infections are reportable infections and if reporting to patients is mandatory.
10. Narrow your spectrum of endocarditis concerns
There is no need to change your prophylaxis based on endocarditis risk for genitourinary procedures
Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association. [published correction appears in: Circulation. 2007;116(15):e376–377]. Circulation. 2007;116(15):1736–1754.
Infectious endocarditis prophylaxis is now only recommended for patients with a prosthetic valve, history of endocarditis, congenital heart disease, or those who have undergone cardiac transplantation.
Acknowledgment
OBG Management acknowledges Mark D. Walters, MD, for review of the manuscript of this article before submission for publication.
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