I PREVENT bacterial resistance. an update on the use of antibiotics in dermatologic surgery.
OBJECTIVE
Prophylaxis may be given to prevent a surgical wound infection, infective endocarditis (IE), or infection of a prosthetic joint, but its use before cutaneous surgery is controversial. Our aim was to review the current literature and provide a mnemonic to assist providers in appropriately prescribing prophylactic antibiotics.


METHODS
We reviewed the current literature, including the new guidelines provided by the American Heart Association (AHA).


RESULTS
The new AHA guidelines recommend prophylaxis for patients with high risk of an adverse outcome from IE instead of high risk of developing IE. The American Academy of Orthopedic Surgeons and the American Dental Association also provide guidelines. Given the paucity of conclusive studies, prophylaxis against a surgical wound infection is based more on clinical judgment.


CONCLUSIONS
The mnemonic we propose, "I PREVENT," represents: Immunosuppressed patients; patients with a Prosthetic valve; some patients with a joint Replacement; a history of infective Endocarditis; a Valvulopathy in cardiac transplant recipients; Endocrine disorders such as uncontrolled diabetes mellitus; Neonatal disorders including unrepaired cyanotic heart disorders (CHDs), repaired CHD with prosthetic material, or repaired CHD with residual defects; and the Tetrad of antibiotics: amoxicillin, cephalexin, clindamycin, and ciprofloxacin.
Moorhead
Christine
C
Department of Dermatology, Loma Linda University, Loma Linda, California, USA. cemoorhead@hotmail.com
Torres
Abel
A
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D062109:Dermatologic Surgical Procedures; D004696:Endocarditis / Q000517:prevention & control*; D006801:Humans; D016459:Prosthesis-Related Infections / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000517:prevention & control*
D000900:Anti-Bacterial Agents