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AL DAR HOSPITAL - MADINA

CLINIC AL PIIAR}IA CY DEPARTMENT

A-lntrsdsellsn
1-. prophylaxis: Administering the putative agent before bacterial contamination
occurS
2. Early therapy: lmmediate or prompt institution of therapy as soon as the patient
presents; usually contamination or infection will have preceded the initiation of therapy (e'9.,
dirty wounds)

B.

L. Clean No entry is made in the resPiratorY,


gastrointestinal, or genitourinary tracts or in the
oropharyngeal cavity. In general, it is elective
with no break in technique and no inflammation
encountered.

2. Clean Entry in the respiratory, gastrointestinal,


contaminated genitourinary, or biliary tracts or oropharyngeal
cavity without unusual contamination' Includes
clean procedures with a minor break in
technique

3. Contaminated Includes fresh traumatic wounds, gross spillage


from the gastrointestinal tract (without a
mechanical bowel preparation), a major break
In technique ,or incisions encountering acute,
nonpurulent inflammation

4. Dirty Includes procedures involving old traumatic


wounds, perforated viscera, or clinically evident
infection

c. lnd,ieatisnsle"rSuraeaj-p'_rsphvlaxis"i

t. Common postoperative infection with low morbidity.


2. Uncommon postoperative infection with significant morbidity and mortality.
AL DAR HOSPITAL - MADINA

CLINIC AL PI{ARIVIA CY DEPARTMENT

o. Pnneiples-qt.P"rsBhylaxisi

1. preoperative- dose timins: Since antibiotics must be present in the tissues at the time of
bacterial contamination (incision) and throughout the operative period; "on-call" dosing is not
acceptable, therefore:
l. the optimal time for administration of preoperative doses is within 60 minutes
before surgical incision. This is a more specific time frame than the previously recommended
time, which Was "at induction of anesthesia" however, Some agents such as
fluoroquinolones and vancomycin , require administration over 1 to 2 hrs; therefore the
administration of these agents should begin within 120 minutes before surgical incision.
ll. Antibiotics should be re-dosed if:
o Surgical procedures lasts longer than 4 hours ( or more than 2 half-lives of
antibiotic).
o There is excessive blood loss during procedure.
o lf there are other factors that may shorten the half-life of the prophylactic
agent (e.g. extensive burns)'
o Readministration of the drug may be also warranted in patients in whom the
half-life of the agent may be prolonged (e.g. patients with renal insufficiency or
failure)

2. Duration of proPhvlaxis:

Most procedures, including gastrointestinal, orthopedic, and gynecologic procedures,


require antibiotics only as long as the patient is in the operating room; administration
beyond surgical closure is not required regardless the presence of indwelling drains and
intravascular catheter . Cardiac procedures may require 24to 48 hours of antibiotics post
surgery.

3. Selection and dosine:


Obesity has been linked to an increased risk for SSl. The pharmacokinetics of drugs may
be altered in obese patients, so dose should be adjusted based on body weight in obese
patient.
4. Spectrum
o Need only activity against skin flora unless the operation violates skin.
o Gastrointestinal, genitourinary, hepato-biliary, and some pulmonary operations
require additional antibiotics.
o Colorectal surgery is one procedure in which broad-spectrum aerobic and
anaerobic coverage is most effective.
o Attempt to avoid a drug that may be needed for therapy if infection occurs.
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