Antimicrobial prophylaxis in orthopaedic surgery : the role of teicoplanin

• Published in: Journal of antimicrobial chemotherapy Vol. 41; no. 3; pp. 329 - 340
• Main Authors: PERITI, P, MINI, E, MOSCONI, G
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.03.1998
• Subjects: Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Arthroplasty, Replacement - adverse effects; Biological and medical sciences; Cephalosporins - administration & dosage; Cephalosporins - adverse effects; Cephalosporins - therapeutic use; Clinical Trials as Topic; Gram-Negative Bacterial Infections - complications; Gram-Negative Bacterial Infections - drug therapy; Gram-Negative Bacterial Infections - prevention & control; Gram-Positive Bacterial Infections - complications; Gram-Positive Bacterial Infections - drug therapy; Gram-Positive Bacterial Infections - prevention & control; Humans; Medical sciences; Pharmacology. Drug treatments; Postoperative Complications - etiology; Postoperative Complications - microbiology; Postoperative Complications - prevention & control; Teicoplanin - administration & dosage; Teicoplanin - adverse effects; Teicoplanin - therapeutic use; Human; Drug combination; Intravenous administration; Toxicity; Single dose; Review; Biological activity; Teicoplanin; Infection; Prevention; Cefuroxime; Antibiotic; Cephalosporin derivatives; Orthopedic surgery; Cefazolin; Treatment; Cefamandole; Glycopeptide; Clinical trial; Drug interaction; Antibacterial agent
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/41.3.329

Orthopaedic joint replacement is generally considered 'clean' surgery characterized by a low incidence of infection. In recent years the use of a clean theatre environment, high local concentrations of antibiotic in the cement and systemic antibiotic prophylaxis have been recognized as important measures to reduce infection rates significantly, and this has been supported by clinical trials. Staphylococcus aureus and Staphylococcus epidermidis cause at least half of all orthopaedic surgical infections. Gram-negative bacilli are involved to a much lesser extent (10-30%). First- and second-generation cephalosporins are currently considered by most authors as standard prophylaxis in elective orthopaedic surgery. In the light of the increasing incidence of methicillin resistance in coagulase-positive and -negative staphylococci, it is becoming more important for antibiotics to act efficiently against such organisms if they are to be of value in prophylaxis in orthopaedic surgery. A combined, single-dose of vancomycin/gentamicin has been used successfully in an open, controlled study in patients undergoing total joint arthroplasty but, given the disadvantages associated with the use of vancomycin, teicoplanin may be an alternative choice in such procedures. This review analyses four comparative trials of the efficacy and safety of teicoplanin, two with cefamandole, one with cefuroxime and one with cephazolin, as prophylaxis in orthopaedic total joint replacement surgery.