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Surgical Antibiotic Prophylaxis Guide

This document discusses antibiotic prophylaxis, which is the use of antibiotics prior to surgery to prevent infections. It describes the different wound classes based on contamination and when prophylaxis is generally required. The key aspects of administering prophylaxis are covered, including choosing an antibiotic based on the expected pathogens and resistance patterns, timing administration within 60 minutes before surgery, using a single dose with a long half-life, and typically administering intravenously. Common antibiotics used for different surgical sites are listed. The risks of prophylaxis include allergies, diarrhea, and antibiotic resistance.

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221 views11 pages

Surgical Antibiotic Prophylaxis Guide

This document discusses antibiotic prophylaxis, which is the use of antibiotics prior to surgery to prevent infections. It describes the different wound classes based on contamination and when prophylaxis is generally required. The key aspects of administering prophylaxis are covered, including choosing an antibiotic based on the expected pathogens and resistance patterns, timing administration within 60 minutes before surgery, using a single dose with a long half-life, and typically administering intravenously. Common antibiotics used for different surgical sites are listed. The risks of prophylaxis include allergies, diarrhea, and antibiotic resistance.

Uploaded by

Ndor Baribolo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

Antibiotic Prophylaxis

Francis Neil C. Caranay


Antibiotic Prophylaxis
Antimicrobial therapy to prevent infection
Given to patients prior to a surgical
procedure
Indications
Class 1 – Clean wounds with implants
Class 2 – Clean contaminated wounds
Class 3 – Contaminated wounds
Class 4 – Dirty wounds
Wound Class and Representative
Procedures
Wound Class Examples of Cases
Class I (Clean) Hernia repair, breast biopsy
Class II (Clean-contaminated) Cholecystectomy, elective GI surgery,
Colorectal surgery
Class III (Contaminated) Penetrating abdominal trauma, large
tissue injury, enterotomy during bowel
obstruction

Class IV (Dirty) Perforated diverticulitis, necrotizing


soft tissue infections
Source: Schwartz’s Principles of Surgery. 9th ed. table 6-8

*Prophylactic antibiotics NOT generally required for Class I


Administration of Antibiotic Prophylaxis
Choice of antibiotic
◦ Antibiotic must cover expected pathogens
◦ Must take into account local resistance
patterns
◦ First choice should be narrow spectrum and
less expensive antibiotics
Timing of administration
◦ IV prophylactic antibiotics should be given
within 60 minutes before skin is incised
◦ IV Vancomycin given starting 90 minutes
prior to skin incision
◦ For Caesarean section, antibiotic is given pre-
incision or after cord clamping
Duration of prophylaxis
◦ Single dose of antibiotic with long enough
half-life lasting throughout the operation
◦ Up to 24 hours for arthroplasty
◦ Additional dosage for cardiac surgery longer
than 4 hours
Route of administration
◦ Antibiotics should be administered
intravenously
◦ Other routes:
 Topical
 Intranasal
 Impregnated cement
 Intracameral
Antibiotic agents used
Penicillins
Cephalosporins
Ampicillin
– sulbactam
Vancomycin
Prophylactic use of Antibiotics
Site Antibiotic Alternative
Cardiovascular Surgery Cefazolin, cefuroxime Vancomycin
Gastroduodenal area Cefazolin, cefoteta, cefoxitin, Fluoroquinolone
ampicillin-sulbactam
Biliary tract with active Ampicillin-sulbactam, Fluoroquinolone plus
infection ticarcillin-clavulanate, clindamycin or
piperacillin-tazobactam metronidazole
Colorectal surgery, Cefazolin plus metronidazole, Gentamicin or
obstructed ertapenem, ticarcillin,- fluoroquinolone plus
small bowel clavulanate, piperacillin- clindamycin or
tazobactam metronidazole

Head and neck Cefazolin Aminoglycoside plus


clindamycin
Neurosurgical Cefazolin Vancomycin
procedures
Orthopedic surgery Cefazolin, ceftriaxone Vancomycin
Breast, hernia Cefazolin Vancomycin

Source: Schwartz’s Principles of Surgery. 9th ed. table 6-6


Risks of Prophylaxis
Allergies/Anaphylaxis
Antibiotic-associated diarrhea
Antibiotic resistance

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