Which antibiotic was administered preoperatively in the open right inguinal hernia repair?

• A. Ancef 1 g IV
• B. Vancomycin
• C. Augmentin
• D. Zosyn

Answer: (B)

Preoperative antibiotic prophylaxis for a clean procedure like open inguinal hernia repair aims to prevent wound infection by covering the skin flora most likely to cause problems, especially Staphylococcus species. In standard cases, a cephalosporin such as cefazolin is used because it is effective, safe, and straightforward. However, when a patient cannot receive beta-lactams—such as due to a severe penicillin allergy—or when there is concern for MRSA colonization or high MRSA prevalence, vancomycin is chosen because it provides reliable coverage against MRSA and other gram-positive cocci that commonly cause surgical site infections. Vancomycin is given IV within about an hour before incision to ensure adequate tissue levels during the procedure.

Augmentin or Zosyn broaden coverage beyond what’s typically needed for a clean inguinal hernia repair, including more anaerobic and some gram-negative activity, which isn’t necessary here and can contribute to unnecessary antibiotic exposure. Ancef is the usual first choice when there’s no beta-lactam allergy or MRSA concern, so vancomycin is the alternative that's best suited for the scenario described.