To the Editor.—I read with concern the design and conclusions of the article by Jacobsen et al.1 Briefly, they concluded that antibiotic prophylaxis is not indicated for the prevention of toxic shock syndrome from nasal surgery, since a single dose of cefazolin failed to eliminate Staphylococcus in nasal carriers. The study reinforces the substantial body of preexisting evidence that a single dose of antibiotic therapy, used for surgical prophylaxis, does not result in significant elimination of skin, respiratory, or colonic flora. Staphylococci are particularly hard to eradicate in the nares, with eradication consistently achieved only by using rifampin (preferably along with another anti-Staphylococcus drug).2,3
Nonetheless, the efficacy of antibiotic prophylaxis in preventing wound infections in "clean-contaminated" cases cannot be denied. This appears to work because the antibiotics administered during the time of surgery provide levels within the wound, including microhematomas and devasculized tissue, such that
POOLE MD. Evaluation of Single-Dose Cefazolin Prophylaxis for Toxic Shock Syndrome. Arch Otolaryngol Head Neck Surg. 1989;115(2):248. doi:10.1001/archotol.1989.01860260122030
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