Single Dose of Gentamicin, Amoxicillin May Reduce Need for Post-Operative Antibiotics

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UK researchers have found that giving patients a single dose of gentamicin and amoxicillin prior to surgery for hip fractures significantly reduced the need for post-operative antibiotics and decreased the incidence of Clostridium difficile, a common infection in healthcare settings.

Richard P. Jeavons, specialist registrar in trauma and orthopedics at Sunderland Royal Hospital in the UK, and colleagues performed a retrospective review of 220 patients following hip hemiarthroplasty surgery. A single dose of gentamicin and amoxicillin was administered to about half of the patients while the remainder received three doses of cefuroxime (brand name Ceftin).

The average length of stay for patients receiving the single-dose antibiotic treatment was 13 days, compared to 17 days for those receiving the three-dose regimen. No patients receiving gentamicin and amoxicillin developed C. difficile infection, while 7 receiving cefuroxime did. Postoperative antibiotic use was also reduced in the gentamicin/amoxicillin group of patients.

The single dose therapy is also more cost effective. Cefuroxime treatments cost between $100 and $199 per day while amoxicillin is less than $25. Treatment of patients with C. difficile can increase costs, because the infection is treated for 10 days with additional antibiotics.

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“We suggest that single-dose antibiotic prophylaxis is as effective as multiple-dose regimes, [it] cuts down the rate of Clostridium difficile, and is more cost effective,” Jeavons said prior to the presentation of his study at the EFORT Congress 2010.

Amoxicillin is a penicillin-like antibiotic that works by stopping the growth of bacteria that cause infections. Brand names include Amoxil and Trimox. Although about one in 10 people report an allergy to the antibiotic, Spanish researchers suggest that symptoms such as skin rash in those treated with amoxicillin is rarely due to a true allergic reaction. Allergy testing by a healthcare provider should be conducted before switching to another medication, say the study researchers.

Gentamicin is another type of antibiotic, given by injection, which treats a wide variety of bacterial infections. Cefuroxime is a second-generation cephalosporin antibiotic given as a tablet or an oral suspension.

Sources Include:

Jeavons RP, Siddiqui B, Jettoo P, et al. Hip fracture antibiotic prophylaxis: 3 dose cefuroxime regime versus single dose gentamicin and amoxicillin. To be presented at the 2010 EFORT Congress. June 2-5, 2010. Madrid.

[Presentation titles: A Study on 56 Children with Amoxycillin - or Amoxycillin With Clavulanic Acid-Related Rashes: True Allergy Is Rare. Abstract 437;
AND
Clavulanic Acid Can Be the Component Responsible for Immediate Hypersensitivity Reactions to Amoxicillin-Clavulanic Acid. Abstract 442]

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