Preventive Antibiotic Management in Surgery

Abstract

The general view of bacterial infection prevalent in medicine today is con cerned with the interaction of host and bacteria, rather than almost exclusively with bacteria as it was a few years ago following the introduction of antibiotic substances. This evolution, which promises to identify methods of infection pre vention, has found vigorous support in surgery because a primary problem in this discipline is the prevention of bacterial disease rather than the elimination of an established septic problem. Postsurgical infection has always been a limiting factor in the development of surgery, and it is not surprising that surgeons greetcd the advent of antibiotics 25 years ago with a vigor born of the expectation that the day of postoperative wound infection was over (1). In the period immediately following the introduction of penicillin and streptomycin, these antibiotics were used widely and indiscriminately in the hope that wound infection would be avoided. What effect this initial euphoria had on the efficiency with which aseptic technique or technical operative accuracy was carried out by surgeons is impor tant but not pertinent here. What is relevant to this discussion is the disillusion following the realization that the new technique did not produce the expected results. The pendulum then swung rapidly from the position where all surgical patients were indiscriminately given antibiotics to the point where, with equal lack of discrimination, no surgical patient was given an antibiotic in an attempt to prevent a postsurgical infection. Recent information stemming from experimental work and the renewed interest in the host and his ability to defend himself has given a more accurate view of the problems of preventing postsurgical infection, and within the past year the pendulum has again begun to swing (2). There is also reason to believe that this traverse will be generated by an increase in the sur geon's ability to prevent postoperative bacterial complications. That is, the changes in preoperative management are based on current biologic information concerning the development of infection as related to the hope that antibiotic substances would eliminate bacteria from tissue at any time, place, or circum stance. It is the purpose of this writing to examine the biologic problems encoun tered in preventing the development of a bacterial infection in the surgical wound as well as to outline a program of clinical management designed to take advantage of the information available.

The effects of preoperative extradural bupivacaine and morphine on the stress response in dogs undergoing femoro-tibial joint surgery

“…1999) although the increased numbers of leucocytes observed by 12 hours in our study suggest that the period of prophylatic therapy required is relatively short. Such a view has been supported by Burke (1973) and Rosin (1988).…”

Analysis of the antibiotic prophylaxis prescribed by Spanish Oral Surgeons

“…However, this behaviour is contrary to antibiotic prophylaxis guidelines, which state that tissue antibiotic levels should be high during the actual procedure (22). In fact, numerous authors have shown that prophylactic administration of antibiotics in the preoperative period can significantly reduce the postoperative wound infection rate (23)(24)(25)(26). Considering the duration of prophylaxis, the latter should be as short as possible as long as it is effective (21).…”

“…According to the consulted literature, when administering the antibiotic via the oral route, a single preoperative dose is sufficient. If the surgical intervention extends in time or tissue damage is considerable, another antibiotic dose can be administered at the equator of its therapeutic interval (22,26,27). In any case, antibiotic prophylaxis should not exceed 24 hours; extended administration does not reduce the infection rate, increases the risk of adverse drug reactions, and facilitates the emergence of bacterial resistances (22,26).…”

Comparison of Preoperative and Perioperative Antibiotic Prophylaxis Regimen in Compound Facial Fractures

“…Postoperatively, the antibiotics can be given in the therapeutic dose of 500 mg every 6 hours. According to Burke,18 prophylactic antibiotic should be repeated every 3 hours during the operation. Prophylactic dosage interval of antibiotics is approximately one-half the usual therapeutic intervals.…”