Antibiotics in Surgery 2003

8/14/2019 Antibiotics in Surgery 2003

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PRESENTED BY :DR. SARAH AZAM

M.O SU1


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ANTIBIOTICS IN SURGERY PROPHYLAXIS

TREATMENT


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ANTIBIOTIC PROPHYLAXIS Fundamental principles of

Surgical Prophylaxis The antibiotic must be in the tissue

before the bacteria are introduced.

There is no data to support more than asingle dose. Further doses generallyconstitute treatment.


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ANTIBIOTIC

PROPHYLAXIS(CONTD.)

The chosen antibiotics must be active against

the most common expected pathogens. High risk patients generally warrant antibiotic

prophylaxis.


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or w c ype ooperations?

All clean-contaminated procedures.

Clean operations with foreign body implant.


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For which type ofoperations?(contd.)

used as treatment when:

contaminated or dirty/infected


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m ng o an o cprophylaxis

Current recommendations are that theparenteral antibiotics used in prophylaxisshould be given in sufficient dosage within 30minutes preceding incision.

the current recommendation is to administera second dose only if the operation lasts forlonger than 2 - 3 hours.


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of prophylacticantibiotics

Intravenous administration of the prophylactic

antibiotic is preferred for most patientsundergoing an operative procedure.

Oral antibiotics currently play a major role

only in the preparation of patients beforeelective colon surgery


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PENETRATION OF

TISSUESDrug must penetrate to the site of infection

CSF ; meningitis


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WHICH DRUGS DO NOT

PENETRATE BODY BARRIERS

Penicillins

CephalosporinsBeta lactamaseinhibitors

Polymixins

Aminoglycosides


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Cross cellular barriers very

readilySulphonamides

Macrolides

TetracyclinesChloramphenicol

FluoroquinolonesMetronidazole

Rifampin


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How does resistance work?


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How does resistance work?


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:PULMONARY,

OESOPHAGEAL 1st generation cephalosporins e.g.

cefazolin 1 - 2 g pre-induction

OR

2nd generation cephalosporins e.g.cefuroxime 1,5 g IV.


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Limb amputation 1st generation cephalosporins eg.

cefazolin 1 - 2 g IV.

OR

cefoxitin 2 g IV.


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GASTRODUODENAL

SURGERY Antibiotics are indicated in high riskpatients only, i.e. patients with bleeding ulcer,obstructive duodenal ulcer, gastric ulcer,decreased GI motility.

1st generation cephalosporins e.g.cefazolin 1 g IV pre-op.

For beta-lactam allergy, gentamicin 120mg plus clindamicin 600 mg IV preop.


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BILIARY TRACT

SURGERY Achieving adequate drainage will

prevent post-procedural cholangitis or sepsis

and there is no further benefit fromprophylactic antibiotics.

Cephalosporins are not active against the

enterococci, yet are clinically effective asprophylaxis in biliary surgery.


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BILIARY TRACT

SURGERY(contd.)With cholangitis, treat as infection, notprophylaxis. High risk patients include those>70 years of age, acute cholecystitis, non-

functioning gall-bladder, obstructive jaundiceor common duct stones.

1st generation cephalosporins e.g.cefazolin 2 g pre-op as a single dose

OR

cefoxitin 2 g pre-op as a single dose.


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INGUINAL HERNIA

REPAIR

Routine use is not recommended. For amesh implant, give prophylaxis e.g. 1stgeneration cephalosporin as a single dose.


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COLON SURGERY Recommended approach for preoperative

preparation before elective colon surgery and

terminal ileal surgery.

Second day prior to surgery Dietary restriction .

Magnesium sulphate, 30 ml of a 50%solution (15 g) orally at 10h00, 14h00 and18h00. In the evening, enemas until clear


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COLON

SURGERY(contd.)PREOPERATIVE DAY

Clear liquid diet, IV fluids as needed.

Magnesium sulphate in dosage as aboveat 10h00 and 14h00.

Neomycin and erythromycin base, 1 geach orally at 13h00, 14h00 and 23h00.Alternative oral antibiotics includemetronidazole plus kanamycin or neomycin.


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COLON

SURGERY(contd.) Day of surgery Cefoxitin 2 g pre-op and every 6 hours for 3doses OR

Metronidazole 500 mg IV pre-op single dose

OR Ampicillin plus metronidazole plus

aminoglycoside all as single doses

OR

3rd generation cephalosporin plusmetronidazole as a single dose

OR for patients with beta-lactam allergy, give

metronidazole 500 mg IV and gentamicin 3 mg/kg

IV pre-operatively, both as single doses.


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COLON

SURGERY(contd.)For non-elective colorectal surgery,

Cefoxitin 1 g IV pre-operatively andthen 1 g 8 hourly for 3 doses


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APPENDICECTOMY

Cefoxitin 2 g IV pre-op and for up to 3doses. If perforated, continue for 3 - 5 days.

For patients with beta-lactam allergy,give metronidazole 500 mg IV pre-operatively.


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PENETRATING

ABDOMINAL TRAUMA Any antibiotic cover can be considered astreatment and not as prophylaxis.

Cefoxitin 2 g IV on admission, continue

q.i.d. for 2 - 5 days for intestinal perforationOR

Metronidazole 500 mg IV and gentamicin1.7 mg/kg IV.

NOT INVOLVING A


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NOT INVOLVING AVISCUS

Recommendations for prophylaxis not available


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UROLOGICAL SURGERYProstatectomyProphylaxis only in high risk patients.

quinolones as a single oral pre-operative dose e.g. ciprofloxacin 500 mg POstat

OR

aminoglycosides as a single IV pre-operative dose


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UROLOGICAL SURGERY(contd.)

Transrectal prostatebiopsy

The quinolones have been shown toreduce bacteraemia from 37% to 7%.


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UROLOGICAL

SURGERY(contd.) Prophylaxis is supported if catheter has

been present for > 24 hours.

Ideally the catheter should be insertedtwo hours or less, prior to surgery.


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UROLOGICAL SURGERY(contd.)Dilatation of urethra, endoscopic diagnostic

procedures, needle biopsy or lithotripsy withsterile urine: prophylactic antibiotics are not

indicated.

Antimicrobials are not recommended prior tourological procedures in patients with sterileurine.


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UROLOGICAL

SURGERY(contd.)

If the urine is infected, it is preferable to

sterilize it before beginning an electiveprocedure.


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HEAD AND NECK

SURGERYIf incision is through oral or oropharyngeal

mucosa:

a. Cefazolin 2 g IV as single doseOR

b. amoxycillin-clavulanate IV 1,2 g as singledose

OR

c. gentamicin 80mg PLUS clindamycin600mg IV as single doses


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SURGICAL SEPSIS(purulent

infections)


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SKIN INFECTIONSBoilsStyes

CarbunclesAntibiotic therapy is usually not indicated


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SKIN

INFECTIONS(continued)Antibiotic therapy is indicated when

boils on face; cavernous sinus thrombosismay result

Immunocompromised patients


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CELLULITISSpreading infection of subcutaneous tissuesAcute pyogenic cellulitis;

Cause is S.PyogenesTreated by Penicillins


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CELLULITIS(contd.)

Anaerobic cellulitisSynergistic infection with both aerobes and

anaerobes.

Treat with penicillin.


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Thanks

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Antibiotics in Surgery 2003