Antibiotics after ACL reconstruction surgery

Antibiotic therapy after ACL reconstruction surgery:

Anterior cruciate ligament Reconstruction is complex but relatively very less invasive surgical procedure mostly performed by arthoscopy. Open surgery are also performed depending upon the extent of injury . When ever there is a surgical procedure antibiotics are very essential in order to prevent from an infection. The antibiotic therapy differs according to the state of patient , treatment protocol of the physician and outcome of the treatment.

In Bangladesh , surgeons usually follow antibiotic protocol in following way:

1. One day before the surgery patient is admitted to the hospital for the anesthesia fitness test and antibiotic prophylaxis. Loading does Antibiotic prophylaxis of cefixime is given 12 hours before the surgery intravenous followed by anti-tetanus intramuscular injection.

2. Just before surgery the maintenance does of cefixime is given intravenously. This assure no any possibilities of an infection.

As the surgery finishes , the patient is taken to the observation room and kept their few hours until the effect on anesthesia is gone and patients vitals are stable. In Bangladesh , the patient is hospitalized up to week and anti-biotic therapy is continued all week. The antibiotic given during this period are :

a. Metronidazole I/V : It is given three time a day (tds) in interval of 8 hours. The purpose of antibiotic therapy is to prevent from decubitus ulcer from the prolonged bed rest and other anaerobic bacterial infection.

b. Amikacin I/V : It is given twice a day (tds) . Amikacin prevent infection in the implant which is foreign to the body . In order to prevent infection associated to implant,

c.Ceftriaxon I/V : Ceftriaxone is given (tds) . Ceftriaxone is broad spectrum and given to prevent again all kind of infection.

This antibiotic are given for 7 days after the surgery. And the oral cefixime is given per oral for a month twice a day.

The miracle drug of the century does not comes with the complication. 

The common side effect associated after the antibiotic therapy are:

1.Hypersensivity

2. Gastrointestinal upset

3. Super infection

4. Nausea , vomiting and loose motion

5. Loss of appetite , weight loss

Few tip for lessening the associated side effects :

1. Eating food containing probiotics (This are the good bacteria that compete with the bad bacteria) like yoghurt and cheese.

2. Informing your doctor about the known sensitivity

3. Maintaining good food and hygiene..

4. Checking signs of infection frequently.

The goal of antibiotic therapy is eradication of infection and prevent initiation of the infection. So , when accomplished the therapy needs to stop.

Even though the strict aseptic environment is maintained during the surgical process , there might comes the chances of infection . The immune status of the patients , existing disease is the person is the most common cause of infection after the procedure.

Infection after ACL reconstruction is extremely rare but very much devastating condition once it occurs. The complications can be very fatal . The chance of infection is 3 per 1000 surgery performed by the same surgeon.

 The common complications are:

1. Arthrofibrosis

2.Graft failure

3. Damage to the capsular ligament.

Symptoms of infection can be checked by the presence of fever , increasing pain around the knee , increase in the swelling and stiffness around the joint.

What after infection?

1. Culture of the specific bacteria causing the infection.

2. Antibiotic sensitivity test.

3. Antibiotic against specific bacteria.

As I said before the treatment protocol varies according to the physician . The same procedure may not be followed by another. So it may differ from place to place and country to country.