Cephalosporin antibiotics as applied in surgery of bones and joints

New cephalosporin antibiotics will continue to be discovered as old forms are found to lose effectiveness. Cephalosporins currently account for a major part of any hospital pharmacy budget. They are often used inappropriately in treatment of both community and hospital infections. Cephalosporins should be used when penicillins are not effective and for particular infections. A major use of cephalosporins is in prophylaxis; cephalosporin antibiotics will not prevent infections caused by organisms that are resistant to these compounds. Infections caused by Enterobacter cloacae, Citrobacter freundii, and Pseudomonas aeruginosa, which are resistant to even third-generation cephalosporins and the monobactams and thienamycins, have been encountered. Wound infections with a deficient blood supply provide situations in which such organisms will grow. It is hoped that proper application of each generation of cephalosporins combined with careful surgical procedures will prevent rapid development of resistance and make it possible to have these drugs as a useful part of our armamentarium for more than just a few years.