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Medications

Cephalosporins NSAIDs
CorticoSteriod Injections  
  Vancomycin

Document discussion of benefits, side effects and complications of any prescibed medications.

Cephalosporins

  • Block the transpeptidase enzyme responsible for cross-linking of polysaccharide molecules in the bacterial cell wall.
  • First Generation (primarily antistaphylococcal with some gram-negative coverage):Cephalothin; Cephapirin; Cephaloridine; Cephalexin; Cefaclor; Cephradine; Cefadroxil
  • SecondGeneration (increased gram-negative coverage with diminished gram-positive coverage): Cefoxitin; Cefamandole; Cefuroxime; Cefotiam; Cefmetazole; Cefonicid; Ceforanide; Cefotetan
  • Third Generation (increased gram-negative coverage with diminished gram-positive coverage): Cefotaxime; Ceftizoxime; Ceftriaxone; Cefmenoxime; Ceftazidime; Cefoperazone; Moxalactam
Gentamycin

Weight (kg)

Gentamicin Dose to Administer (1.5 mg/kg/dose)

30-40 

60 mg

41-50

70 mg

51-60

90 mg

61-70

100 mg

71-100

120 mg

> 100 kg

Consider aztreonam 2 g

  • for wound breakdown:  Gentamycin/NS, 15mg/100ml; 250ml bottle; topical wet/dry dressing to wound BID. 

Corticosteriod Injections

  • MOA: suppression of angiogenesis; decreased neutrophil migration into the joint; and decreased production of inflammatory mediators.
  • Risks: Transient flare (24-48hrs; facial flushing; transient serum cortisol suppression; hyperglycemia (DM);tendon rupture; nerve injury (intra-fasicular); infection; accelerated joint degeneration; lipodystrophy; skin hypopigmentation. (TTTIL)
  • Contraindications: Infection (articular, cellulitic, or systemic), known hypersensitivity reaction, osteochondral fracture, joint arthroplasty, uncontrolled bleeding disorder.
  • (Fadale PD, Wiggins ME: Corticosteroid injections: Their use and abuse. J Am Acad Orthop Surg 1994;2:133–140)
  • (Cole BJ, JAAOS 2005;13:37)

Vancomycin

  • MOA: Inhibits cell wall synthesis.
  • Indications: methicillin resistant S aureus and Staphylococcus epidermidis: patients withhypersensitivity reactions to the penicillins

NSAIDs (Nonsteriodal Anti-Inflammatory Drugs)

  • Inhibit the production of porstaglandins in the cyclooxygenase (COX) pathway.
  • Side Effects: dyspepsia, ulcer perforation, hemorrhage, cardiovascular, renal
  • COX-2 inhibitors designed for decreased GI side effects. Celecoxib has not shown any statistically significant increased CV events compared to NSAIDs. Rofecoxib and valdecoxib have been withdrawn due to increased CV events.
Prophylactic Antibiotics for Orthopaedic Procedures
  • Most common Pathogens:  S.aureus, S. epidermidis
  • Recommeded: cefazolin 1-2 grams IV q8h For up to 24 hours
  • Alternatives: clindamycin 600 mg IV q8h or vancomycin 1 gram IV q12h
Diclofenac Sodium 1.5% topical (Pennsaid)
  • indicated for knee osteoarthritis