The comments by Dr Moskovitz are appreciated and deserve further explanation. We recognize that new antimicrobials with relatively long half-lives (eg, cefonicid, ceforanide, and ceftriaxone) have been shown to be effective when used prophylactically in single preoperative doses; however, the literature supports the older and less expensive, "first-generation" cephalosporins (eg, cefazolin) as being effective for prophylaxis when administered in single preoperative doses. Traditionally, older cephalosporins have been studied for surgical prophylaxis using regimens where two to 20 postoperative doses were provided in addition to a preoperative dose.1 Where these agents have been studied using only single preoperative doses, they have been found effective.1 Multidose regimens are not, therefore, generally "necessary." For example, Lewis et al2 reported recently that a single preoperative dose of cefazolin is effective in decreasing postoperative infection rate in high-risk biliary surgery. Our own investigations have demonstrated that cefazolin produces adequate intraoperative
DiPiro JT, Bowden TA, Hooks VH. The Prophylactic Use of Cephalosporins for Surgery-Reply. JAMA. 1985;253(23):3399–3400. doi:10.1001/jama.1985.03350470051016
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