Guidelines for Complications of Cancer Treatment Vol VIII Part B

should be based on the isolates from any institute andtheir antibiotic sensitivity pattern.Timing and dosage of antimicrobial prophylaxisThe goal of antimicrobial prophylaxis is to achieve serum andtissue drug levels that exceed, for the duration of the operation,the minimum inhibitory concentrations for the organisms likelyto be encountered.a. Peak serum and bone concentration of antibioticstypically occur within 20 minutes of systemicadministration 3 . It is therefore reasonable to administera prophylactic antibiotic 30 to 60 minutes before skinincision 9 .b. Vancomycin infusion should begin within 60 minutesbefore skin incision, to prevent antibiotic-associatedreactions.a. Arthroplasties that require a tourniquet should have theentire antimicrobial dose before the tourniquet isinflated 9 .b. For prolonged procedures, or procedures associated withextensive blood loss, an additional intraoperative doseof antibiotic is advised 18,19 .c. For obese patients, higher doses of cefazolin (2 g) arerequired 16 .Duration of antimicrobial prophylaxisThe optimal duration has yet to be determined.1. Several studies have reported no additional benefit whenprophylaxis was continued beyond 24 hours 20-24 .2. The current consensus on the duration of prophylaxisfor a routine joint arthroplasty is a single preoperativedose, followed by two to three postoperative doses 25 tominimize toxicity, cost, and antimicrobial resistance.127