Question

Which of the following is the drug of choice for preoperative antibiotic prophylaxis in a patientundergoing cardiac surgery?

• A. Penicillin G
• B. Erythromycin
• C. Azithromycin
• D. Cefazolin

Answer 1

The Correct Option is D

In the context of preoperative antibiotic prophylaxis for cardiac surgery, the primary goal is to prevent postoperative infections. It's essential to choose an antibiotic that covers the common pathogens encountered during surgical procedures, particularly Gram-positive cocci such as Staphylococcus aureus and Staphylococcus epidermidis.

Cefazolin is the drug of choice in this scenario for several reasons:

• Spectrum of Activity: Cefazolin is a first-generation cephalosporin with excellent activity against Gram-positive bacteria, including Staphylococcus species, which are common causes of surgical site infections.
• Pharmacokinetics: It has a favorable pharmacokinetic profile, achieving adequate tissue levels at the time of surgical incision and maintaining them throughout the procedure.
• Safety Profile: Cefazolin is well-tolerated and has a low incidence of allergic reactions compared to alternatives.
• Administration: It is administered intravenously, allowing for rapid onset of action, which is crucial for prophylaxis.

Given the considerations above, the correct choice for preoperative antibiotic prophylaxis in a cardiac surgery patient is Cefazolin.

Antibiotic	Reason for Selection
Cefazolin	Effective against Gram-positive bacteria, good pharmacokinetics, safe, fast-acting
Penicillin G	Narrower spectrum
Erythromycin	Not ideal for this setting due to limited spectrum and side effects
Azithromycin	More suitable for atypical infections

To summarize, Cefazolin's effectiveness, safety, and administration advantages make it the preferred choice for preoperative prophylaxis in cardiac surgery.