antibiotic prophylaxis - Forum

[forceps]

I am operating upon a 50 yr. old female for total mastectomy. She has
an immunologic deficiency dealing with chemotactic activity. Her
immunologist says she needs to be on IV antibiotics for 14 days post op
to prevent infection and help with healing. I have never heard of such
a thing. Any comments?

[Surgeon]

More about this please. Does it have a name, and what is the defect?

[John Dissector]

Why not 21 days? What's wrong with 7 days? why not a month?

Where did your immunologist found the magic figure of 14 days?

In terms of clean surgery - an immunosuppressed patient is not different
from any patient; the contamination-if any-occurs DURING the operation;
after the operation the wound is rapidly-within few hours- sealed. So
NOTHING, NOTHING can change the fate of the wound AFTER the operation which
is determined DURING the operation . This is true for any type of patient.

Your patient needs a good antiseptic bath to decrease her skin flora,
PERI-OPERATIVE antibiotics, careful hemostasis, avoidance of
bacteria-loving suture material (i.e. silk) and nothing else.

Ask your immunologist to provide you with references to justify the 14
days. Tell him he talks nonsense!

[forceps]

More about this please. Does it have a name, and what is the defect?

I understand it is called hyper IgG syndrome. This interferes with
chemotactic activity. The patient tells me she heals well for a few
days and then has problems. I also found out she takes doxycycline
chronically. The operation went well. I sent her home on a couple days
of cephelexin as a compromise.