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Antibiotic prophylaxis

Antibiotic prophylaxis refers to the prevention of ing to data on pharmacology, microbiology, clinical exinfection complications using antimicrobial therapy (most perience and economy. Drugs should be selected with a
commonly antibiotics).
reasonable spectrum of activity against pathogens likely
Even when sterile techniques are adhered to, surgical pro- to be encountered, and antibiotics should be chosen with
kinetics that will ensure adequate serum and tissue levels
cedures can introduce bacteria and other microbes in the
throughout
the risk period.
blood (causing bacteremia), which can colonize and infect dierent parts of the body. An estimated 5 to 10 percent of hospitalized patients undergoing otolaryngology
(head and neck) surgery acquire a nosocomial (hospital) infection, which adds a substantial cost and an average of 4 extra days to the hospital stay.

For prophylaxis in surgery, only antibiotics with good tolerability should be used. Cephalosporins remain the preferred drugs for perioperative prophylaxis due to their
low toxicity. Parenteral systemic antibiotics seem to be
more appropriate than oral or topical antibiotics because
the chosen antibiotics must reach high concentrations at
all sites of danger. It is well recognized that broadspectrum antibiotics are more likely to prevent gramnegative sepsis. New data demonstrate that third generation cephalosporins are more eective than rst and
second generation cephalosporins if all perioperative infectious complications are taken into consideration. Dermatologic surgeons commonly use antibiotic prophylaxis
to prevent bacterial endocarditis. Based on previous studies, though, the risk of endocarditis following cutaneous
surgery is low and thus the use of antibiotic prophylaxis
is controversial. Although this practice is appropriate for
high-risk patients when skin is contaminated, it is not recommended for noneroded, noninfected skin.[1]

Antibiotics can be eective in reducing the occurrence of


such infections. Patients should be selected for prophylaxis if the medical condition or the surgical procedure
is associated with a considerable risk of infection or if a
postoperative infection would pose a serious hazard to the
patients recovery and well-being.

Microbial infections

Local wound infections (supercial or deep-sided),


urinary tract infections (caused by bladder catheter, inserted for surgery), and pneumonia (due to impaired
breathing/coughing, caused by sedation and analgesics
during the rst few hours of recovery) may endanger the
health of patients after surgery. Visibly worse are postoperative bacterial infections at the site of implanted foreign
bodies (sutures, ostheosynthetic material, joint replacements, pacemaker implants, etc.) Often, the outcome of
the procedure in question and even the life of the patient
is at risk.

2.2 Duration of antibiotic administration

Prophylaxis of the shortest possible duration should be


aimed at in order to minimize the risk of serious adverse eects or dangerous development of resistance.
The minimum frequency of administration is the single
dose, which usually produces fewer adverse eects than
the multiple dosage and at the same time often represents
2 Prevention of microbial infection the most economical form of administration. There is
controversy about uoroquinolone antibiotic prophylaxis
in neutropenic patients as there are little benet, e.g. no
Worldwide experience with antimicrobial prophylaxis in reduced mortality and because the risks likely outweigh
surgery has proven to be eective and cost-ecient, both the benets.[2]
avoiding severe patient suering while saving lives (provided the appropriate antibiotics have been carefully cho- The goal of antimicrobial prophylaxis is to achieve sufsen and used to the best of current medical knowledge). cient antibiotic tissue concentrations prior to possible
contamination in the relevant tissues and to ensure adequate levels throughout the operative procedure to prevent subsequent bacterial growth. Of crucial importance
2.1 Antibiotic selection
for success in surgical prophylaxis is the timing of adA proper regimen of antibiotics for perioperative prophy- ministration of short-acting antibiotics, as persistent anlaxis of septic complications decreases the total amount timicrobial activity throughout the entire operation is esof antimicrobials needed and eases the burden on hospi- sential; the longer a surgical procedure lasts, the longer
tals. The choice of antibiotics should be made accord- an appropriate antibiotic tissue level must be maintained.
1

This can be achieved either by repeated administrations


or by giving a single dose of a suitable long-lasting antimicrobial.
Also, by extending the antimicrobial cover some hours
beyond the duration of the actual surgical procedure, it
is possible to reduce the perioperative infection rates of
urinary and respiratory septic complications considerably
(provided an adequately broad spectrum antibiotic prophylaxis is chosen).

2.3

Advantages of long-acting antibiotics

Long-acting, broad-spectrum antibiotics oer the following advantages by comparison to short-acting antimicrobials in perioperative prophylaxis:
A single dose covers the whole perioperative risk period - even if the operation is delayed or long-lasting
- and with regard to respiratory and urinary tract infections
Repeat administrations for prophylaxis are not necessary, so that additional doses are less likely to be
forgotten (an advantage of practical value in a busy
working situation such as a hospital)
Less risk of development of resistance and less side
eects
Increased compliance and reduced errors of administration
Possibly better-eectiveness (less material and labor
cost, less septic perioperative complications)

References

[1] Scheinfeld N, Ross B. Antibiotic prophylaxis guideline


awareness. Dermatol Surg. 2002;28:841-4. "[PMID
12269880]"
[2] Kleinberg, M. (Sep 2004). Counterpoint: routine antibacterial prophylaxis is not indicated in neutropenic patients with hematological malignancies.. J Natl Compr
Canc Netw 2 (5): 44551. PMID 19780253.

Resources
Antimicrobial Therapy in Otolaryngology Archived
11 December 2005 at the Wayback Machine
Guidelines for Antimicrobial Usage 2008-2009 Tables 29 - 31 from the Cleveland Clinic
Antimicrobial prophylaxis Virginia-Maryland Regional College of Veterinary Medicine
Disease Management Project Online Medical Reference from the Cleveland Clinic

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