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Re: Антибиотикопрофилактика
послал Gerry Packman 28 Июль 2003, 12:35
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In the USA, in the state of New Jersey, a state organization that oversees medical care called th PRO (Peer Review Organization) has virtually mandated that, if the orthopedist wishes to use prophylactic antibiotics for a knee or hip replacement, they must be given immediately prior to surgery, and for no more than 24 hrs after surgery.
There is some leeway for the "immediately" prior to surgery, to allow for some antibiotics that can be given "IV push" as opposed to those that must be given more slowly. Any other methodology must be justified on the basis of
something more than pure prophylaxis. The PRO has also identified the appropriate antibiotics to be used (1st generation cephalosporin) and other antibiotics only with a reason (e.g., allergy).
The regulation is not terribly wrong, but many of us are not sure that it is absolutely better than any other method. Even of it is, it may not stay the best in the future, and will be hard to change. Hospital are being monitored,
and if "out of compliance" will be penalized.
Currently the regulation is only for prophylactic antibiotics for hip and knee replacements, but with the state's stamp of approval for these procedures, it is likely that most of us will use the same routine for other orthopedic procedures. For procedures done with a tourniquet, it makes sense (but not
double-blind experimental certainty) to give the antibiotic early enough to get out of the vascular space, into the tissue space.
I hope this gives you some useful information. I feel better for having "vented" a bit.
Regards,
Gerry Packman
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