Modern Surgical Antibiotic Prophylaxis and Therapy—Less Is More
- 1 April 2000
- journal article
- review article
- Published by Mary Ann Liebert Inc in Surgical Infections
- Vol. 1 (1), 23-29
- https://doi.org/10.1089/109629600321263
Abstract
Recent findings and recommendations on the use of antibiotics in surgery, both prophylactically and as therapy, suggest that adverse events associated with antibiotics remain a major cause of morbidity and mortality. Wound infection rates generally parallel the presence of one or more of three key risk factors; the overall medical condition of the patient, a prolonged operative time, and a contaminated or dirty operative field. The first choice of prophylactic drug should generally be a first- or second-generation cephalosporin, unless the patient is highly allergic to penicillin. Effective prophylaxis can almost always be achieved with a single dose of antibiotic, but the dose must be administered soon before the incision. New guidelines for the prevention of bacterial endocarditis have reduced both the types of cases that require prophylaxis, and the doses of antibiotic necessary to achieve prophylaxis. Some cases that required endocarditis prophylaxis previously no longer require prophylaxis. Rational antibiotic therapy demands rapid diagnosis and treatment. It is also crucial to distinguish among infection, contamination, and inflammation as soon as possible; contamination requires only a single dose of antibiotic, whereas sterile inflammation requires none at all. The choice of antibiotic for postoperative infection, including intra-abdominal infection, should consider the severity of illness and the risk of resistant bacteria. Failure to stratify for risk may prolong treatment unnecessarily, confound the interpretation of future studies, and increase the prevalence of bacterial resistance.Keywords
This publication has 25 references indexed in Scilit:
- Prevention of bacterial endocarditis. Recommendations by the American Heart AssociationJAMA, 1997
- Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study GroupJAMA, 1995
- Comparative antimicrobial activity of piperacillin-tazobactam tested against more than 5000 recent clinical isolates from five medical centers a reevaluation after five yearsDiagnostic Microbiology and Infectious Disease, 1995
- Minimal antibiotic therapy after emergency abdominal surgery: A prospective studyBritish Journal of Surgery, 1994
- Multicenter evaluation of the in vitro activity of piperacillin-tazobactam compared with eleven selected β-lactam antibiotics and ciprofloxacin against more than 42,000 aerobic gram-positive and gram-negative bacteriaDiagnostic Microbiology and Infectious Disease, 1994
- Surgical wound infection rates by wound class, operative procedure, and patient risk indexAmerican Journal Of Medicine, 1991
- Antibiotic Prophylaxis in Trauma: Penetrating Abdominal Injuries and Open FracturesClinical Infectious Diseases, 1991
- Pseudomembranous colitis associated with single-dose cephalosporin prophylaxisPublished by American Medical Association (AMA) ,1989
- Efficacy of Preoperative Antimicrobial Preparation of the BowelAnnals of Surgery, 1972