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In Reply.—Poole agrees, and, in fact, emphasizes that staphylococci are notoriously difficult to eradicate from the nose. Our study confirms this, and we conclude that, because single-dose cefazolin "prophylaxis" permits carriage to persist, it is unlikely to have a major effect on reducing the incidence of toxic shock syndrome (TSS) following nasal surgery.
Poole does not define what he means by a "standard antibiotic prophylaxis regimen," but we would concede that drugs, routes, frequencies, and durations other than the one we studied could certainly produce an effect other than the one we observed.
Poole's point about the efficacy of some antibiotic regimens preventing wound infections in particular circumstances is true, but its relevance to postoperative TSS is not entirely clear. In the case of menstrually associated and postnasal surgery TSS, there is relatively little evidence of infection per se, as evidenced by tissue invasion and local polymorphonuclear cell reaction.
JACOBSON JA, KASWORM E, STEVENS MH. Evaluation of Single-Dose Cefazolin Prophylaxis for Toxic Shock Syndrome-Reply. Arch Otolaryngol Head Neck Surg. 1989;115(2):248. doi:10.1001/archotol.1989.01860260122031
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