In Reply.
—The first-generation cephalosporins have enjoyed wide popularity as prophylactic agents to prevent postoperative infections in specific surgical procedures classified as "clean" and "clean-contaminated."1 The universal application of these agents for these defined indications can be attributed to the following factors: these antibiotics are nontoxic, relatively inexpensive, and possess activity for those major pathogens (ie, Staphylococcus aureus or coliforms) likely to be encountered in the operative area. Confirmation of their efficacy in selective procedures has been repeatedly documented in prospective, randomized, controlled studies.2,3We believe the third-generation cephalosporins are not indicated for perioperative prophylaxis. These compounds exert less activity for S aureus. Although the third-generation cephalosporins exert greater activity against the Enterobacteriaceae than the first-generation or second-generation cephalosporins, the preferred prophylactic agent need not be active against every bacterial species present. Third-generation cephalosporins are considerably more expensive than first-generation cephalosporins, and no study has proved their clinical