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.
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