From the Guidelines
Recommended Antibiotic Choice for Infection Following Myomectomy
The recommended antibiotic choice for infection following a myomectomy is typically a first-generation cephalosporin, such as Cefazolin, due to its broad spectrum of coverage, low cost, and low allergenic potential 1.
Key Considerations
- Antibiotic Administration: Antibiotics should be administered within 1 hour of incision to obtain the highest drug serum levels at incision 1.
- Dosing: The dose should be increased in obese patients (BMI ≥ 35) 1.
- Anaerobic Coverage: Additional anaerobic coverage is recommended if the bowel is entered during pelvic surgery for cancer 1.
- Alternative Options: In patients with penicillin or cephalosporin allergy, a combination of intravenous clindamycin and gentamycin or a quinolone (e.g., ciprofloxacin) is recommended 1.
- Duration of Therapy: The duration of antibiotic therapy should be tailored to the individual patient's response, but generally ranges from 24 to 48 hours for uncomplicated cases, and up to 7-10 days for more severe infections 1.
Important Factors
- Patient-Specific Factors: Antibiotic selection may vary based on patient-specific factors, such as allergy history and local antimicrobial resistance patterns 1.
- Local Resistance Patterns: The choice of antibiotic should be based on local epidemiology among uropathogens 1.
- Surgical Site Infections: Surgical site infections (SSI) are common, with rates up to 23.5% reported in patients undergoing a laparotomy, and substantially increase the overall risk of financial catastrophe for patients in low-middle-income countries 1.
Summary
A first-generation cephalosporin, such as Cefazolin, is the recommended antibiotic choice for infection following a myomectomy, with consideration of patient-specific factors, local resistance patterns, and surgical site infection rates 1.
From the FDA Drug Label
Cefoxitin for Injection, USP is indicated for the prophylaxis of infection in patients undergoing ... abdominal hysterectomy The recommended antibiotic choice for infection following a myomectomy (surgical removal of uterine fibroids) is Cefoxitin.
- The dosage is:
- 2 grams administered intravenously just prior to surgery (approximately one-half to one hour before the initial incision)
- followed by 2 grams every 6 hours after the first dose for no more than 24 hours 2 Key points:
- Cefoxitin has a broad spectrum of activity against gram-positive and gram-negative bacteria, including anaerobes
- It is effective in preventing infection in patients undergoing abdominal hysterectomy, which is similar to myomectomy 2
From the Research
Antibiotic Choice for Infection Following Myomectomy
The recommended antibiotic choice for infection following a myomectomy (surgical removal of uterine fibroids) is not directly addressed in the provided studies. However, the studies provide information on the treatment of anaerobic infections, antimicrobial prophylaxis for colorectal surgery, and antibiotic treatment of intra-abdominal and post-surgical infections.
Key Findings
- Anaerobic infections are generally polymicrobial, and therapy should provide coverage of both aerobic and anaerobic pathogens 3.
- The most effective antimicrobials against anaerobic organisms are metronidazole, carbapenems, chloramphenicol, and combinations of a penicillin and a beta-lactamase inhibitor 3.
- Antimicrobial prophylaxis for colorectal surgery reduces the risk of surgical wound infection, and the best antibiotic choice, timing, and duration of administration remain undetermined 4.
- Antibiotics covering aerobic and anaerobic bacteria delivered orally or intravenously prior to elective colorectal surgery reduce the risk of surgical wound infection 4.
- The antibiotic therapy for the treatment of intra-abdominal infections varies according to the infection severity, and a combination treatment covering anaerobes, Gram-negative rods, and Gram-positive cocci is recommended for severe infections 5.
- Necrotizing soft tissue infections are frequently polymicrobial, and initial antibiotic coverage with a broad-spectrum regimen is warranted 6.
- The bacteriology of postoperative abdominal infections is dominated by aerobic and anaerobic Gram-negative bacilli, and anaerobic bacteria are more prevalent in infections originating from sites with a faecal flora 7.
Antibiotic Options
- Metronidazole
- Carbapenems (imipenem, meropenem, and ertapenem)
- Chloramphenicol
- Combinations of a penicillin and a beta-lactamase inhibitor (ampicillin or ticarcillin plus clavulanate, amoxicillin plus sulbactam, and piperacillin plus tazobactam)
- Cephalosporins
- Clindamycin
- Aminoglycosides
- Imidazole drugs
Note: The choice of antibiotic should be based on the specific clinical scenario, including the severity of the infection, the suspected or confirmed pathogens, and the patient's medical history and allergies.