Guidelines for Complications of Cancer Treatment Vol VIII Part B

124be wasteful, but potentially hazardous in terms oftoxicity, and the increased risk of developingbacterial resistance.e. The antimicrobial prophylaxis examined in thereview were administered parenterally, orally, orin antibiotic-loaded cement. The results of trialsin this area are inconclusive. The cost and ease ofadministration should, therefore, be used todetermine which route should be used.f. These reviews are from elective total jointArthroplasty and cannot be directly applied toOncology reconstructions. This is an inherentlyhigher risk group. However broad principlesemerge from the data which can be applied.Selection of antimicrobial agentThe optimal antibiotic should have activity against commonorganisms in prosthetic joint infections (Staphylococcus orStreptococcus spp); a long half-life; excellent tissuepenetration; a lack of toxicity; and be relatively inexpensive.1. Cefazolin, a first-generation cephalosporin, meets all thedesired criteria 3 and is the most widely used antibioticat present. Vancomycin and clindamycin arerecommended as alternative agents for patients who havea true type I b-lactam allergy, manifested by immediateurticaria, laryngeal edema, or bronchospasm 4 .2. The use of vancomycin in orthopedic surgery prophylaxisshould be limited:a. Vancomycin is an inferior antistaphylococcal agentfor methicillin-susceptible strains, compared withcephalosporins and penicillinase-resistantpenicillins 5,6 . There are no prospective comparativedata on the clinical efficacy of cephalosporin