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Surgical Practice
Department of Surgery, UHWI
Introduction
Antibiotic use may be
prophylactic or therapeutic
Must decide which use is
appropriate
The decision to use and how is the
surgeon’s responsibility
Antibiotic use is often unscientific
and haphazard
This will encourage resistance and
negatively influence outcomes
Factors Influencing Antibiotic
Use In Surgical Patients
Pre Operative Factors:
Intercurrent diseases (DM, AIDS,
Prostheses)
Wound Factors (soilage, location)
Operative Factors
Duration,Location, Contamination,
Instrumentation
Post Operative Factors
Pre Operative Factors
Patient Parameters: Age
Extremes, DM, AIDS, Steroids
Wound Parameters: Skin prep,
wound soilage, devitalization,
wound size and location
Surgeon/Op Theatre Parameters:
Theatre protocol, surgeon
preference
Principles of Wound
Infection Prophylaxis-(1)
Select effective AB for likely
pathogens
Single agent almost always
effective
1/2-life must be enough to maintain
levels throughout operation
First dose not more than 2 hrs
before skin incision, preferably
immediately before incision
Principles of Wound
Infection Prophylaxis-(2)
Give second dose if procedure
>3hrs or 2x 1/2-life of AB
Post-op doses generally
uneccessary beyond 24 hr
If it is felt that AB required beyond
24 hours then give a full
therapeutic course, to discourage
development of resistant
organisms
Intra Operative Factors
Meticulous Operative Technique
Duration
Haemostasis/perfusion
Spaces
Tissue Handling
Cautery use
THERAPEUTIC COURSE OF
APPROPRIATE ANTIBIOTIC
USUALLY REQUIRED
Dirty or Infected Case
Acute bacterial inflammation w/o
pus
Transection of clean tissue to allow
access to collection of pus
Traumatic wound with devitalized
tissue, FB, Faeces
Fresh wound caused by dirty
source
Delayed treatment of traumatic
wound
Dirty or Infected Case,
con’td
Always require
THERAPEUTIC
COURSE OF
ANTIBIOTICS
Special Cases-(1)
Endocarditis Prevention
Valvular Heart Disease
VSD
PDA
Prostheses
Cardiac
Vascular
Bowel Preparation
Neomycin
Special Cases-(2)
Superficial Abcess
Non-diabetic or
immunosuppressed patient
Non-vital location
No prostheses
Hands
Face/Scalp
THERAPEUTIC ANTIBIOTICS
REQUIRED
Summary
Antibiotics used judiciously can
improve outcomes
Use/abuse of antibiotics is
surgeon’s responsibility