Guidelines for Complications of Cancer Treatment Vol VIII Part B

5. A systematic review of 25 RCT’s on antibiotic prophylaxisfor total hip replacement was published in 1999 2 . Theoverall rate of surgical wound infection across all theincluded trials of antimicrobial prophylaxis for THRsurgery was 1% (2.1% when total knee replacement(TKR) patients were included). Staphylococcus aureusand Staphylococcus epidermidis were the mostfrequently isolated pathogens in the trials included inthe present review.a. Surgical wound infection (SWI) rates can bestatistically significantly reduced when anantimicrobial is used prophylactically, comparedwith placebo or no intervention.b. However, trials to date provide inconclusiveevidence on the optimal antimicrobial prophylaxisregimen. The comparative efficacy of antimicrobialprophylaxis for THR (and TKR) surgery wasdifficult to demonstrate, mainly due to the lowinfection rates and the small sample sizes of thetrials.c. Cephalosporins (first and second generation) werethe most commonly studied antibiotics. There isno convincing evidence to suggest that thirdgenerationcephalosporins are more effective thanfirst- and second-generation cephalosporins inpreventing SWIs in THR surgery.d. The duration of the antimicrobial prophylacticregimen examined in the included trials varied froma single dose to a 14-day course. There is noevidence to suggest that administeringantimicrobial prophylaxis for more than 1 daypostoperatively reduces the number of infectionsfollowing THR surgery. Extending the duration ofa regimen for longer than 24 hours may not only123