EDITOR: We wanted to find out about the current practice of antibiotic prophylaxis in cardiac surgery. A telephone survey was conducted in 64 cardiac surgical hospitals in France, and a questionnaire was sent to 70 other European institutions whose anaesthesiologists were affiliated to the European Association of Cardiothoracic Anaesthesiologists (Austria, Belgium, Denmark, Finland, Germany, Ireland, Italy, The Netherlands, Norway, Spain, Switzerland, Sweden, UK). Anaesthesiologists were asked which antibiotic prophylaxis they commonly used in scheduled cardiac surgery. Replies were received from 56 centres in France and from 47 centres in other countries. The total number of patients operated upon in these centres was 51 405 per year. Eighteen centres used a first generation cephalosporin: cefazolin (n = 14), cefalotin (3), cefodizim (1). Sixty-seven centres used a second generation cephalosporin: cefamandole (44), cefuroxime (23). One institution used a third generation cephalosporin: cefotaxim. Five centres used penicillins: cloxacillin (3), dicloxacillin (1), flucloxacillin (1). One centre used amoxycillin-clavulanic acid. Four centres used a glycopeptide, one used a tetracycline and one used colimycin. A second antibiotic was associated in five centres: gentamicin (3), netilmicin (1), vancomycin (1). The first dose of antibiotic was administered before the incision except in three centres. The antibiotic prophylaxis was strictly administered during the operation in 18 centres. Prolonged antibiotic prophylaxis was maintained for 6-24 h in 40 centres, for 25-48 h in 39, for 72 h in five, and until removal of the chest drainage tube in one centre. The survey shows that most institutions prescribe a second generation cephalosporin for >6 h. Table 1 shows data from the present survey and two others [1,2]. The present survey was performed a few months after publication of the French Society of Anaesthesiologists Guidelines in 1999 [3]. These guidelines recommended administration of either cefazolin, cefamandole or cefuroxime only during operation in non-allergic patients. However, these recommendations had not yet been applied in most of the centres. When comparisons are made with previous surveys performed in the USA [1] and Germany [2], there is a trend towards prescribing more second generation cephalosporins. Such an attitude would satisfy authors of a recent meta-analysis, which suggests that second generation cephalosporins are more effective than first generation cephalosporins in cardiac surgery [4]. The use of reserve antibiotics, e.g. glycopeptides and third generation cephalosporins - implying risks of emergence of resistant pathogens - was avoided in most institutions.Table 1: Results of three surveys.Prolonged administration of antibiotics after cardiac surgery was reported in >73% of institutions. However, it is becoming increasingly accepted that both limited use during the actual operation and use over a prolonged period are equally effective approaches [5,6]. Moreover, the combination of a second antibiotic with a first or a second generation cephalosporin does not seem to enhance efficacy [7]. In conclusion, adequate antibiotic prophylaxis seems to be prescribed, but a reduction in its duration appears desirable in most institutions. Further surveys should be performed to assess modifications of practice in this important issue of perioperative medicine. J. J. Lehot S. Helou Service d'Anesthésie Réanimation; Hôpital Cardiovasculaire et Pneumologique Louis Pradel; Lyon, France O. Bastien Équipe d'Accueil 1896; Faculté Rockefeller; Université Claude Bernard Lyon I; Lyon, France