First Tier Versus Second Tier Antibiotics for Surgical Site Infections Following Hysterectomy In the Patients With a Beta-Lactam Allergy: A Prospective, Randomized, Single-Blinded Clinical Trial

In this prospective, randomized, single-blinded clinical trial, eligible subjects will be identified based on scheduled elective hysterectomy. Subjects with documented beta-lactam allergy in their chart will be evaluated to differentiate true allergy and allergy-like events. Subjects with history of allergy-like event to beta-lactam antibiotics will be randomized to either receive first tier antibiotic or second tier antibiotics before anesthesia induction.

Preoperative Screening of Allergy The potential subjects' history of allergy will be reviewed according to described criteria of allergy like events. Subjects with documented anaphylaxis to first tier and second tier antibiotics will be excluded. Only subjects with a history of previous allergic-like event after beta-lactam antibiotic will be enrolled to the study.

An allergy self-screening questionnaires will be reviewed before the surgery to identify true allergy or allergy-like event to beta-lactam (penicillin). Allergic-like events include nausea, vomiting, feeling dizziness, dermatitis seen after beta-lactam antibiotic, or any other description of hypersensitivity reactions other than anaphylactic shock, angioedema, laryngeal spasm, and shock. Administration of the potential confounding drugs such as antihistamines, systemic and topical corticosteroids and potential confounding diagnosis such as autoimmune disease will be also reviewed together with allergy history of the subjects to differentiate true hypersensitivity and allergy-like events to penicillin and other beta-lactam antibiotics.

Postoperative Follow-up for SSI:

Subjects will be followed postoperatively for post-discharge SSIs or clostridium infection by reviewing medical records and contacting via phone and survey. If the subject received care outside the clinic, their provider will be contacted to obtain outside clinic record with subject permission.