Antimicrobial Prophylaxis for Surgical Wounds

Abstract

Prophylactic administration of antibiotics can decrease postoperative morbidity, shorten hospitalization, and reduce the overall costs attributable to infections. Principles of prophylaxis include providing effective levels of antibiotics in the decisive interval, and, in most instances, limiting the course to intraoperative coverage only. Use in The National Research Council clean contaminated operations is appropriate and, in many instances, has been proven beneficial. Antibiotic prophylaxis is also indicated for clean operations, such as those involved with insertion of prosthetic devices, that are associated with low infection risk and high morbidity. Extension of antibiotic prophylaxis to other categories of clean wounds should be limited to patients with two or more risk factors established by criteria in the study of the efficacy of nosocomial infection control (SENIC) because the baseline infection rate in these patients is high enough to justify their use. Cefazolin (or cefoxitin when anaerobic coverage is necessary) remains the mainstay of prophylactic therapy. Selection of an alternate agent should be based on specific contraindications, local infection control surveillance data, and the results of clinical trials. Newer criteria for determining the risk of "site infection" (wound and intracavitary) are in evolution and may lead to modification of these recommendations over the next several years.

Antibióticos em tonsilectomias: terapêutico ou profilático? Necessário ou abusivo?

“…[1][2][3]5,6 Adult patients commonly require up to two weeks to fully recover after tonsillectomy. 3 Besides the trauma of the surgery itself, which includes all variables resulting from the technique applied (cold dissection/cold knife technique, electric/hot knife dissection, laser, coblation etc. ), the key tissue reaction to the presence of microorganisms is inflammation.…”

“…Pain and discomfort are symptoms of significant magnitude postoperatively, even after therapy with narcotic drugs. 3 Oropharyngeal pain after tonsillectomy derives from the tonsillar fossa. The exposure of nervous terminals and the action of chemical inflammatory mediators such as lactic acid, leukotrienes and prostaglandins resulting in muscle spam are the cause of such pain.…”

“…4 The pain-related issues resulting from such inflammatory healing process may include hospitalization for IV hydration and pain killer therapy. 1,3,6 In 1956, Orzac tested the use of oral antibiotics therapy preoperatively and IM postoperatively to decrease morbidity and detected pain relief after tonsillectomy, lower number of hemorrhage events and of several types of infection. 8 In 1986, Telian carried out the first clinical trial, a prospective, randomized, controlled study widely mentioned in the literature to test the effects of antibiotic drugs in tonsillectomy recovery in pediatric patients.…”

“…2 Therefore, it is reasonable to assume that reduction of bacterial population at the open surgical wound may decrease local inflammation, promote healing process and accelerate recovery. 3 This hypothesis originated several studies that addressed the relation between perioperative use of antibiotics and postoperative morbidity of adenotonsillectomy. There are several well designed studies available in the literature (level A evidence), advocating the use of antibiotics to decrease postoperative morbidity of tonsillectomy (fever, halitosis, oral feed intake and return to normal routine).…”

“…There are several well designed studies available in the literature (level A evidence), advocating the use of antibiotics to decrease postoperative morbidity of tonsillectomy (fever, halitosis, oral feed intake and return to normal routine). [1][2][3][4] Although these studies define themselves as designed to evaluate prophylactic surgical use of antibiotics in such surgeries, there were no follow up about internationally accepted surgical antibiotic prophylaxis, that is, up to two hours preoperatively until six hours postoperatively. 5 The objective of this article is to discuss pros and cons of the use of antibiotics in tonsillectomy through a critical review of literature to properly define its use.…”