A comparison of teicoplanin and cefuroxime as prophylaxis for orthopaedic implant surgery: a preliminary report

Abstract

The relative merits of different antibiotic regimens for prophylaxis in orthopaedic implant surgery are difficult to evaluate because of the low frequency of infection. Factors other than infection prevention may influence choice. We have compared 400 mg teicoplanin given intravenously on induction of anaesthesia with three perioperative injections of cefuroxime, in 146 patients undergoing total hip or total knee replacement. These interim results suggest that cefuroxime selects for increased extraintestinal carriage of faecal streptococci and teicoplanin for Proteus species. There were no significant differences between the regimen in the acquisition of coagulase-negative staphylococci or Clostridium difficile, post-operative diarrhoea, wound healing or wound infection. Both regimens were equally safe.

Antibiotic prophylaxis for wound infections in total joint arthroplasty

“…24 Seven studies were from North America, 25-31 two from East Asia 32,33 and 17 from Europe, 28,34-49 12 were singlecentre 26,29,32,33,35,[41][42][43]46,48,[48][49][50] and 12 multicentre trials 27,28,30,31,36,37,39,40,44,45,47,51 and in two data were not reported. 25,38 There were two studies which reported only TKR patients, 32,33 11 THR patients, [34][35][36][37][38][39][40][41][42][43]50 11 both THR and TKR patients, [26][27][28][29][44][45][46][47][48][49][50] one THR, TKR and other undefined ...…”

“…31 In five double-blind 26,27,34,37,52 and five singleblind 33,42,45,46,49 studies there was insufficient information as to who was blinded. A total of 12 did not describe blinding.…”

“…Baseline characteristics were adequately reported and well-balanced in 17 studies, [26][27][28][29][30][31][32][33]37,[41][42][43][44][45]47,48,50 but unclear in nine. 25,34,35,[38][39][40]46,49,52 Eligibility criteria were undefined in one study 25 and unclear in another. 38 Four presented an intention-to-treat analysis, 27,29,36,37 eight did not but gave sufficient data to allow us to do so.…”

Regional Prophylaxis with Teicoplanin in Monolateral or Bilateral Total Knee Replacement: an Open Study

“…The optimal duration of prophylaxis in joint replacement procedures, however, is still debatable. The efficacy of single-dose cephalosporin as a prophylactic regimen is uncertain (10), although single-dose prophylaxis with long-half-life agents appears to be reasonable: in four comparative randomized studies, single-dose teicoplanin was found to have efficacy and safety equivalent to those of multiple-dose cephem antibiotic (cefazolin, cefamandole, or cefuroxime) regimens in the prevention of infection following total hip replacement or TKR (28,30 At present, teicoplanin is not considered a first-choice drug for prophylaxis of joint prosthetic surgery. Nevertheless, it displays a good spectrum of activity against primary pathogens responsible for postoperative infection in orthopedic surgery and particularly against both methicilin-sensitive and MR staphylococci, which are the most commonly isolated pathogens in postoperative infectious complications following joint replacement.…”

Bioactive-Coated Implants in Trauma Surgery

“…When combined with large foreign bodies such as prostheses or other implants, bone infections are very hard to treat. In some cases the implant supports the infection and, as a result, has to be removed [2,19,20], often making it necessary to carry out multiple revision operations and give longterm treatment with antibiotics [21][22][23][24].…”