Which of the following is a first-generation cephalosporin commonly used for perioperative prophylaxis due to activity against Staphylococcus aureus and streptococci?

• A. Cefuroxime
• B. Cefdinir
• C. Cefixime
• D. Cefazolin

Answer: (D)

When preventing postoperative infections, the goal is to cover the most common skin flora—Staphylococcus aureus and streptococci. First-generation cephalosporins excel at this, offering strong activity against these gram-positive cocci with limited gram-negative coverage, which is ideal for perioperative prophylaxis. Cefazolin is the classic first-generation cephalosporin used IV for this purpose because it reliably achieves good tissue levels quickly and is well suited for prophylaxis in many clean surgical procedures. That’s why cefazolin is the go-to choice for perioperative prophylaxis due to its activity against Staphylococcus aureus and streptococci. The other options either emphasize broader gram-negative activity (later generations) or are oral agents with less reliable Staph coverage, making them less ideal for this use.