Evaluation of new cephalosporins for prophylaxis of surgical infection

The appropriate use of recently marketed cephalosporins for antimicrobial prophylaxis during surgery is discussed. New cephalosporins (cefamandole, cefoxitin, cefotaxime, moxalactam, and cefoperazone) are often substituted in situations where older, "first-generation" cephalosporins or other antimicrobials traditionally have been used. Adoption of these newer agents for routine use in prophylaxis of surgical infection has led to concerns of substantially increased costs as well as development of bacterial resistance. To date, some of the newer cephalosporins have been investigated for prophylaxis of postoperative infection in cesarean section, vaginal hysterectomy, gastrointestinal surgery, open-heart surgery, and total-hip replacement. Assessment of new cephalosporins for surgical prophylaxis should include: (1) the nature of infection with each specific type of procedure, (2) the effect of antimicrobials on prevention of infection with specific procedures, and (3) factors related to the institutional environment. For the surgical procedures listed above, newer cephalosporins either have not been studied or studies have not demonstrated a reduction in postoperative infection rates in comparisons with "first-generation" cephalosporins. Valid prophylactic uses for the newer agents may arise if comparative studies demonstrate postoperative infection rates lower than with regimens using the older cephalosporins or with other established regimens. Currently, none of the newer cephalosporins can be recommended for routine use in the prophylaxis of surgical infection.