Leading articles epidemic involving hospital staff. Lancet ii: 540^3 (1975). Medical Research Council Report. Treatment of Whooping Cough with antibiotics. Lancet i: 1109-1112(1953). Trollfors, B. Effect of erythromycin and amoxycillin on B. pertussis in the naso-pharynx. Infection 6: 228-30 (1978).

Prophylaxis—has it at last come of age ?

of surgical procedures including the seniority of the surgeons, the degree of haematoma formation, the use of drains, haemovacs, etc., rarely are mentioned as major factors which can contribute to the success or failure of a prophylactic programme. Such factors explain the divergent infection rates in 'untreated controls' which range from 2 % infected to 50 % infected (Condon, 1975). The theoretical advantages proposed for prophylactic antibiotics include protection of healthy susceptible individuals exposed to potentially serious infectious agents, prevention of infection at the site of implacement of necessary foreign bodies, i.e. hip prosthesis, valvular prostheses, or protection of individuals susceptible to recurrent infection by virtue of underlying biologic predisposition or medication. However, these advantages are mitigated by the toxic and hypersensitivity reactions to antibiotics, the risk of superinfection, particularly with more resistant species, and the selection of resistant bacteria in the environment. Equally serious adverse results of prophylactic therapy are the encouragement of sloppy, careless surgical or medical practices and the possibility that infection is masked only to appear much later resulting in greater damage to the body. The underlying concept of antibiotic prophylaxis is based on work of Miles and colleagues (Miles, Miles & Burke, 1957), in which application of an antibiotic at an area of surgical trauma or contamination was able to act in concert with cellular and humoral host defences to prevent local infection. What seems to have escaped many individuals is that the duration of protective use must be short, perhaps 8 to 12 h and no longer than 48 h to obviate toxic effects of the antibiotics, and the selection and emergence of a resistant flora in the institution (Burke, 1961). Although animal experiments of endocarditis by a number of groups (Durack

Prophylaxis--has it at last come of age?

Leading articles epidemic involving hospital staff. Lancet ii: 540^3 (1975). Medical Research Council Report. Treatment of Whooping Cough with antibio...
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