What alternative antibiotic can be given to a post-operative orthopedic patient who is allergic to Keflex (Cephalexin)?

From the Guidelines

For a post-operative orthopedic patient with a Keflex (cephalexin) allergy, I recommend clindamycin 300-450 mg orally every 6 hours for 7-10 days as the first-line alternative. This recommendation is based on the guidelines for the diagnosis and management of skin and soft tissue infections, which suggest clindamycin as a suitable alternative for patients allergic to penicillins, including cephalosporins like Keflex 1. Clindamycin provides coverage against common orthopedic wound pathogens, including Staphylococcus aureus and streptococci. Some key points to consider when prescribing clindamycin include:

• Potential side effects, such as diarrhea, which can be mitigated with probiotics or antidiarrheal medications
• Monitoring for signs of Clostridioides difficile infection, which can be a complication of clindamycin use
• Ensuring the patient understands the dosing schedule and potential side effects Other alternatives, such as azithromycin or amoxicillin-clavulanate, may also be considered, depending on the specific surgery, infection risk, and nature of the allergy 1. However, clindamycin remains the first-line choice due to its efficacy and safety profile. It's essential to clarify the exact nature of the Keflex allergy to determine the best course of treatment.

From the FDA Drug Label

Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Clindamycin is also indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylococci Its use should be reserved for penicillin-allergic patients or other patients for whom, in the judgment of the physician, a penicillin is inappropriate. To reduce the development of drug-resistant bacteria and maintain the effectiveness of clindamycin hydrochloride and other antibacterial drugs, clindamycin hydrochloride should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria

For a post-op ortho patient who is allergic to Keflex (a type of penicillin), clindamycin can be considered as an alternative antibiotic option.

• The dosage for adults is 600 mg to 1,200 mg per day in 2,3, or 4 equal doses for serious infections due to aerobic gram-positive cocci and the more susceptible anaerobes.
• In more severe infections, the dosage can be increased to 1,200 mg to 2,700 mg per day in 2,3, or 4 equal doses 2 3.

From the Research

Alternative Antibiotics for Post-Op Ortho PT Allergic to Keflex

• For patients allergic to Keflex (a type of cephalosporin), alternative antibiotics can be considered based on the type of infection and the patient's specific allergy profile 4.
• In the case of methicillin-susceptible Staphylococcus aureus (MSSA) infections, cefazolin or antistaphylococcal penicillins can be used, but caution is advised in patients with a penicillin allergy due to potential cross-reactivity 5, 6.
• For methicillin-resistant Staphylococcus aureus (MRSA) infections, vancomycin, daptomycin, or ceftobiprole can be used 5, 7.
• In patients with a reported penicillin allergy, the use of beta-lactam alternative antibiotics (such as clindamycin or vancomycin) may increase the risk of surgical site infection, highlighting the importance of careful antibiotic selection 4.

Considerations for Orthopaedic Surgery

• Prophylactic antibiotics are commonly used in orthopaedic surgery, with the goal of preventing surgical site infections 8.
• The choice of antibiotic and duration of treatment can vary depending on the specific procedure, patient factors, and hospital guidelines 8.
• In patients allergic to Keflex, alternative antibiotics such as vancomycin or clindamycin may be considered for prophylaxis, but the decision should be made on a case-by-case basis, taking into account the patient's allergy profile and the specific surgical procedure 4.