Cefotaxime and prophylaxis. New approaches with a proven agent.

Cefotaxime, a third-generation cephalosporin, is active against many troublesome gram-negative organisms and anaerobes that now more frequently cause nosocomial infection. Single-dose cefotaxime, 1 g or 2 g administered 30 minutes prior to surgery, has been proven to be effective as prophylaxis for infection following gastrointestinal, biliary, obstetric, gynecologic, and genito-urinary procedures. When published trials are compiled, single-dose cefotaxime is more effective than multiple-dose cefazolin (p less than 0.01) in these types of surgery. Unfortunately, the dramatic increase in cephalosporin use has been accompanied by the emergence of resistant organisms such as enterococci and fungi. In Europe, some centers successfully prevent nosocomial pneumonia in intubated patients by decontaminating gastric contents with a combination of nonabsorbable antimicrobial agents including cefotaxime. Further trials may validate this concept for use in the United States.