If a patient is allergic to cephalosporins, which antibiotic is used for surgical prophylaxis?

If a patient is allergic to cephalosporins, which antibiotic is used for surgical prophylaxis?

• A. Vancomycin
• B. Penicillin
• C. Aztreonam
• D. Levofloxacin

Answer: (A)

In surgical prophylaxis for someone with a cephalosporin allergy, you choose an antibiotic that covers the most likely wound pathogens without using a beta-lactam. Vancomycin is ideal here because it provides strong coverage against Gram-positive organisms, including MRSA, and it is not a beta-lactam, so it avoids any cross-sensitivity concerns with cephalosporins. While penicillin is a beta-lactam and would be avoided in this setting due to the allergy, aztreonam mainly covers Gram-negative bacteria and does not reliably cover Staphylococcus aureus, which is a common cause of surgical site infections. Levofloxacin has activity against some Gram-negatives and Gram-positives but is not preferred for routine prophylaxis due to resistance concerns and spectrum limitations. Thus vancomycin best meets the need to prevent infection when cephalosporins cannot be used.

In surgical prophylaxis for someone with a cephalosporin allergy, you choose an antibiotic that covers the most likely wound pathogens without using a beta-lactam. Vancomycin is ideal here because it provides strong coverage against Gram-positive organisms, including MRSA, and it is not a beta-lactam, so it avoids any cross-sensitivity concerns with cephalosporins. While penicillin is a beta-lactam and would be avoided in this setting due to the allergy, aztreonam mainly covers Gram-negative bacteria and does not reliably cover Staphylococcus aureus, which is a common cause of surgical site infections. Levofloxacin has activity against some Gram-negatives and Gram-positives but is not preferred for routine prophylaxis due to resistance concerns and spectrum limitations. Thus vancomycin best meets the need to prevent infection when cephalosporins cannot be used.