Symposium on Medical Evaluation of the Preoperative Patient

Antimicrobial Prophylaxis Neil M. Flynn, M.D. M.D. ~:o:' M.D.':'~:' and Ruth M. Lawrence, M.D.':":'

Infections accompanying surgical procedures contribute significantly to surgical morbidity and mortality. In this article we will examine the use of antimicrobial agents to reduce infection in patients requiring surgical treatment. In some instances, data contained in the literature on antimicrobial prophylaxis permit relatively specific recommendations as to the best available prophylactic regimen. In others, recommendations must be based on a paucity of confirmatory information, and represent hypotheses which must be tested clinically and modified according to the results of such testing. Finally, the low infectious morbidity of many operative procedures does not justify prophylaxis with its attendant risks of toxicity and promulgation of antimicrobial resistance.

PRINCIPLES OF PROPHYLAXIS As in other areas where antimicrobial agents are used preventively, surgical prophylaxis requires adherence to certain principles. The drugs used must be relatively nontoxic and effective against the organisms most likely to be encountered in the surgical site, and the risk of infection following the procedure must be greater than the risk inherent in the use of the antimicrobial agent. Timing is crucial in successful surgical prophylaxis-an effective concentration of drug must be present in the operative site at the time of the procedure when bacterial contamination occurs. Burke 44 has demonstrated that antibiotics must be given within a few hours of the time that tissue is infected with staphylococci to prevent infection and are most effective if given prior to the time of bacterial contamination. Prophylactic antimicrobials should be continued for a relatively short time postoperatively to prevent the emergence ofresistant of resistant organisms. The antibacterial agents used will be dictated by the types of or':'Assistant >:'Assistant Professor of Medicine, University of California, Davis, School of Medicine, U.C. Davis Medical Center, Sacramento, California >:o:

Antimicrobial prophylaxis.

Symposium on Medical Evaluation of the Preoperative Patient Antimicrobial Prophylaxis Neil M. Flynn, M.D. M.D. ~:o:' M.D.':'~:' and Ruth M. Lawrence,...
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