“UPDATE ON INFECTIOUS DISEASE”
PATRICK DUFF, MD (JUNE 2009)
Dr. Duff’s recommendations for therapy are most helpful. He includes a recommendation for antibiotic prophylaxis in penicillin-allergic patients undergoing perineal repair, but not for women undergoing cesarean delivery. What is Dr. Duff’s recommendation in that case?
Jane Helwig, MD
Lancaster, SC
Dr. Duff responds:
A combination of drugs is recommended
Dr. Helwig poses a very thoughtful question. If a patient has an immediate, life-threatening allergy to beta-lactam antibiotics, she should not receive a cephalosporin antibiotic for prophylaxis. Rather, I would give a single dose of clindamycin (900 mg intravenously [IV]) plus gentamicin (1.5 mg/kg of actual weight, IV) plus azithromycin (500 mg IV). The first two drugs can be administered rapidly. However, azithromycin should be administered slowly over the course of 1 hour. We begin the infusions before surgery.