Apologies if this violates it rules, as I am a medical student asking a question in no small part for my benefit for exams, but I do fundamentally want to know the answer to this as it pertains to real-world clinical practice. I believe this post is within the rules of the subreddit since it is ultimately about clinical practice.
Essentially, we've been taught (between classes and third-party pharmacology resources for board exams) that cefazolin has the benefit of having both a broad gram-positive spectrum and a long half-life, making it useful for pre-op antibacterial prophylaxis. Board resources mention that cefoxitin is particularly useful and used for the same purpose, but specifically in abdominal surgery.
I didn't understand the mechanism or reason for this distinction, so I've been looking for answers online. Stanford's 2017 Surgical Antimicrobial Prophylaxis Guidelineslist cefazolin (either as monotherapy or combined with vancomycin or metronidazole) as the preferred agent for every surgical type except for "Open/laparoscopic involving intestine," in which case cefoxitin is the indicated preferred agent.
So what is the real-world indication for surgical prophylaxis with regard to picking either cefazolin or cefoxitin, and why? Why does Stanford indicate cefoxitin specifically for urological surgery involving the intestine over the usual cefazolin? Are GI or Urology surgery patients at particular risk for infection by gram-negatives not covered by Cefazolin?
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