Abstract
Introduction: With recent concerns about the prevalence of Clostridium difficile, some Orthopaedic departments have changed their antibiotic prophylaxis for hip arthroplasty patients. Are these decisions evidence-based and are the changes in the best interests of the patient? We have gathered information from hospitals across the UK to investigate whether prophylactic regimens are changing and what is driving this change.
Methods: Information was gathered using a questionnaire. This was sent via e-mail to hospitals in the Mersey Deanery, the East Anglian Deanery and other hospitals across the UK.
Results: Replies were received from 21 hospitals in total. The vast proportion is still using cefuroxime 1.5g on induction with 2 post-op doses of cefuroxime 750mg. Those that have changed are mainly using flucloxacillin/gentamicin although decisions regarding prophylaxis are being driven by microbiologists/management (cost implicated in 10%) rather than clinicians/clinical evidence.
Discussion: The AAOS has recommended that antibiotics used for prophylaxis should be carefully selected. They should be consistent with current recommendations in the literature, taking into account issues of resistance and patient allergies. In 2007, the DoH recommended prudent antibiotic prescribing to reduce the use of broad spectrum antibiotics as an important component in preventing and controlling Clostridium difficile. Nelson postulated in a Cochrane Database Review in 2007 that in treating Clostridium difficile-associated diarrhoea in adults, teicoplanin appeared to be the best choice because evidence suggests that it is better than vancomycin for bacteriologic cure and has borderline superior effectiveness in terms of symptomatic cure. The combination of teicoplanin (covering Gram positive organisms including MRSA and enterococci) an gentamicin (covering aerobic Gram negatives and staphylococci) would surely be in the best interests of the patient despite the cost.
Correspondence should be addressed to BHS c/o BOA, at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, England.
