Editorial: Antibiotic Prophylaxis for Hip Fracture Surgery: Three-Dose Cefuroxime versus Single-Dose Gentamicin and Amoxicillin

Abstract

in orthopaedic practice. In this issue, Jettoo et al.1 investigated issues related to (1) single versus multiple doses of antibiotic prophylaxis, (2) adverse effects of multiple dosing, and (3) choice of an appropriate antibiotic. In an attempt to address the concomitant problems of cefuroxime-resistant pathogens and Clostridium difficile infections, the authors’ hospital changed the antibiotic prophylaxis regimen from 3 doses of cefuroxime to a single dose of gentamicin plus amoxicillin. The authors made a historical comparison (2006 and 2008) of 2 groups of hip arthroplasty patients who received these 2 different antibiotic protocols in terms of incidence of C difficile infection, length of hospital stay, use of postoperative antibiotics, and overall 180-day mortality. Without doubt, antibiotic prophylaxis reduces SSI in hip fracture surgery.2,3 A meta-analysis showed a highly significant 45% relative risk reduction with antibiotic usage (p=0.008). The incidence of infection in the treatment group was half that in the controls (5.4% vs. 10.4%), and the number needed to treat was 20.2 Whether a single dose of antibiotics is sufficient compared to antibiotic prophylaxis for 24 to 48 hours is not known. A meta-analysis failed to demonstrate superiority of multiple-dose prophylaxis over a singledose strategy.4 Available data do not show superiority of either regimen in preventing postoperative wound infection.5 The issue remains unresolved because of the relatively low incidence of SSI. A multicentre randomised controlled trial with a large number of patients per arm (over 10 000) is needed to detect small differences.4 Editorial: Antibiotic prophylaxis for hip fracture surgery: three-dose cefuroxime versus single-dose gentamicin and amoxicillin