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In Reply.—Dr Lord's comments about the use of topical antibiotics are appropriate and of considerable interest. As he indicates, topical drugs may achieve phenomenal concentrations that are not achieved with systemic administration. Indeed, replenishment of the environment with topical antibiotics every 3 to 10 minutes will likely overcome any deficiencies that may arise from unfavorable systemic drug pharmacokinetics.
While an enormous body of literature has demonstrated the effectiveness of preoperative systemic antibiotics in many areas of surgical practice, the same cannot be said for topical antibiotics. Studies with topical drugs have not controlled for the timing of drug administration or the frequency of reapplication, and many have the confounding variable of synchronous systemic drug administration. Dr Lord's description of frequent and repeated topical administration should improve wound infection rates.
Proving that point, particularly if simultaneous systemic drugs are administered, will be nearly impossible. Dr Lord's repeated excellent results with
FRY DE, PITCHER D. Antibiotic Prophylaxis-Reply. Arch Surg. 1991;126(5):656-657. doi:10.1001/archsurg.1991.01410290134031