Keflex before and after rhino?

Question

I have a history of c.diff and have been prescribed 500 mg 3x a day of keflex (cephalexin) to take starting the day prior to my surgery. I am having a primary rhinoplasty, a revision septoplasty and a tip graft using septum. I am very wary of taking the antibiotics but am also concerned the surgeon will not proceed if I do not. I was also given sodium fusidate ointment 2% to use topically prior to surgery. I have expressed my concerns over c.diff to my surgeon. What is your advise?

Christopher C. Chang, MD · Answer

Thank you for your question.

Your risk for C.Diff is relatively low with a short course of keflex.  Other antibiotics can give you a greater predisposition, but usually this is when you have been on antibiotics for 2+ weeks.  Taking some probiotics would also potentially help stave off this risk.

On the flip side, if you have discussed this with your surgeon, he/she should be willing to limit the antibiotics to minimize your risks - as in most surgeries, prophylactic antibiotic dosing only has to be done with a single dose before incision and occasionally for 24 hours post op.  If your surgeon is OK with that plan, it may also allay your fears of C.Diff.

Your surgeon likely has your best interest in mind if they are trying to push the Keflex, because they are trying to make sure you don't have any post operative complications or infection - you just have to be willing to balance that with your other concerns.

Hope that helps,

Christopher C. Chang, MD

Washington DC, Maryland, and Virginia

Fred J. Bressler, MD, FACS · Answer

You should discuss your concerns with your physician and perhaps consult with an infectious disease specialist about peri-operative strategies for C. Difficile. There are some good options to help prevent a problem. First, most cases of C.Difficile do not appears for 4-9 days while on antibiotics. A short course of antibiotics for rhinoplasty many not trigger your condition. Second, some patients will take yogurt between antibiotic doses to help maintain normal colonic flora. Third, some patients will start taking oral metronidazole (Flagyl) antibiotic prior to starting Kelfex, which should decrease the risk for C. Difficile colitis. These are a few strategies that appear in the medical literature. Your physician can best guide you as to your particular situation. Simply choosing to not take your antibiotics is not the best option. Please discuss your concerns and agree to a plan of action. Hope this helps.

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