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In this episode, episode 60, I welcome Andrew Jarrell, one of our amazing surgical ICU pharmacists to the show. We discuss antibiotic prophylaxis for surgery including what to use, how to time it, how long to continue it, and what the evidence says about things like indwelling drains.
CME: https://earnc.me/MthcTD
A fantastically helpful outline of the episode put together by Brian Park is here: Outline
Thank you for covering this topic, enjoyed it!
Kind regards, Flo
Do you have a reference for the dosing of ancef 1-3 minutes pre incision being ok? My staff doesnt seem to believe me.
Hi Jim,
Here’s Andrew’s response:
The data surrounding this point are actually well-reviewed in the ASHP Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery (Am J Health-Syst Pharm. 2013;70:195-283). As we discussed on the podcast, there is some mixed data on ideal timing of pre-op cefazolin, but two studies I would point to suggesting that administration 1-30 minutes pre-incision is at least as effective as administration 31-60 minutes pre-incision are van Kasteren MEE et al. Clin Infect Dis. 2007;44:921-927 and Steinberg JP et al. Ann Surg. 2009;250:10-16. A couple pharmacokinetic studies (DiPiro JT et al. Arch Surg. 1985;120:829-832 and Stitely M et al. Surg Infect. 2013;14:455-459) demonstrated tissue concentrations of cefazolin well above goal within 12-20 minutes after administration, but did not precisely answer the question of exactly how long it takes to reach goal tissue concentration. Because the data are not completely clear, the ASHP guidelines recommend administration of cefazolin any time within 60 minutes prior to incision.