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D E C E M B E R 2 0 1 4 | O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E
•
Give cephalosporin 30 to 60 minutes before incision.
The most common
antibiotic agent in the outpatient setting is a 1
st
or 2
nd
generation
cephalosporin, reserving the use of vancomycin and fluoroquinolones for
patients with documented ß-lactam allergies. A 2009 article in the
Annals of Surgery reports that administration of a non-vancomycin/non-
quinolone antibiotic such as a cephalosporin provides the most prophy-
laxis when administered within 30 minutes of incision. The article states
that the infection risk with antibiotic administered within 30 minutes of
incision was 1.6%, compared with 2.4% when antibiotics were adminis-
tered between 31 to 60 minutes before surgery. To avoid confusion
regarding administering of cephalosporins, it appears that optimal timing
is 30 to 60 minutes before surgical incision. As long as it is within 1 hour,
you're meeting the SCIP measure. Studies have not proven any advan-
tage in administering the antibiotic in less than 30 minutes.
•
Give vancomycin and fluoroquinolone 90 to 120 minutes before incision.
This is more complex. You must infuse these agents within 2 hours
before incision, as there are non-infection-related risks involved with
too rapid an administration schedule with these agents. For example,
"red man syndrome," a potential adverse effect that may occur after
vancomycin administration, has been thought to be a result in some
patients of too rapid administration of the medication. This is not true
for all patients, but the pharmaceutical companies recommend that
you infuse the drug over the course of 90 to 120 minutes. This poses a
significant issue in outpatient surgery, as patients aren't always in the
center and ready for IV infusion at the optimal time for vancomycin
and fluoroquinolones to be administered.
— Dan O'Connor
SURGEONS'
Lounge
THE
