Overview of cephalosporin prophylaxis

After an uncertain and highly controversial beginning, the use of antimicrobials for prophylaxis of surgical wound infection has evolved to represent state-of-the-art management of the surgical patient. Although a truly ideal prophylactic antimicrobial does not exist, the cephalosporins, particularly those of the first generation, have emerged as the mainstay of prophylaxis in surgery. However, new pathogens and newly recognized problems have necessitated a comparative evaluation of a wide variety of antibiotic regimens. The choice of an appropriate antibiotic is complicated by the lack of an adequate experimental model of infection in clean and clean-contaminated surgical procedures. Moreover, clinical trials have proved to be an inefficient method of comparing antibiotic regimens, as important variations in risk factors for infection cannot be reliably controlled. Significant differences exist among cephalosporins and between the cephalosporins and other classes of antimicrobials in several clinically important parameters: antimicrobial spectrum, serum half-life, ease of administration, tissue penetrability, cost, and incidence of allergy and toxicity. New generations of cephalosporins and new classes of antibiotics have demonstrated the potential to out-perform the first-generation cephalosporins in many of these areas. Although the first-generation cephalosporins were essential in establishing the efficacy of antibiotic prophylaxis in surgery, there are no guarantees that this class of cephalosporin, or that any cephalosporin, for that matter, will continue to dominate the prophylactic arena.