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Antibiotic guidelines in surgery, especially antibiotic prophylaxis. Prophylactic antibiotics in general surgery, cardiothoracic, vascular, orthopedic,neurosurgery, Classification of wounds. Guidelines of prophylactic antibiotics
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Guidelines for antibiotic Guidelines for antibiotic useuse
By Doctor SaleemBy Doctor Saleem
Holy Family Hospital RawalpindiHoly Family Hospital Rawalpindi
Surgical wound classificationSurgical wound classificationaccording to contaminationaccording to contamination
Clean: Uninfected operative wound in which no
inflammation is encountered and the respiratory, alimentary, genital, or infected urinary tract are not entered. Wounds are primarily closed and, if necessary, drained with closed drainage.
Infection rate 3.3%
Clean contaminatedClean contaminated
Operative wound in which the respiratory, alimentary, genital or urinary tracts are entered under controlled conditions and without unusual contamination
Infection rate 10.8%
ContaminatedContaminated
Open, fresh, accidental wounds. In addition, operations with major breaks in sterile technique or gross spillage from the gastrointestinal tract, and incisions in which acute, nonpurulent inflammation is encountered are included in this category
Infection rate 16.3%
DirtyDirty
Old traumatic wounds with retained devitalized tissue and those that involve existing clinical infection or perforated viscera. This definition suggests that the organisms causing postoperative infection were present in the operative field before the operation.
Infection rate 28.6%
Antibiotic Prophylaxis GuidelinesAntibiotic Prophylaxis Guidelines
A single preoperative dose of antibiotic is as A single preoperative dose of antibiotic is as effective as full five days course of therapy effective as full five days course of therapy assuming uncomplicated procedure.assuming uncomplicated procedure.
Prophylactic antibiotics should be Prophylactic antibiotics should be administered within 1 hour prior to incision, administered within 1 hour prior to incision, preferably with induction of anesthesia.preferably with induction of anesthesia.
Prophylatic antibiotics should target Prophylatic antibiotics should target anticipated organisms.anticipated organisms.
Contd;Contd; Prophylaxis should not be extended beyond 24 hours Prophylaxis should not be extended beyond 24 hours
following surgery.following surgery. One preoperative and two or three postoperative One preoperative and two or three postoperative
doses are sufficient in clean surgery.doses are sufficient in clean surgery. Contaminated and dirty procedures should Contaminated and dirty procedures should
additionally receive additional postoperative additionally receive additional postoperative coverage.coverage.
During prolonged procedures antibiotic prophylaxis During prolonged procedures antibiotic prophylaxis should be readministered every 3 hours.should be readministered every 3 hours.
Use of antibiotic in procedures classified as Use of antibiotic in procedures classified as contaminated or infected should be used as contaminated or infected should be used as therapeutic and not prophylactic.therapeutic and not prophylactic.
Contd;Contd;
In traumatically injured patients antibiotics cannot be In traumatically injured patients antibiotics cannot be given before bacterial contamination occurs.given before bacterial contamination occurs.
Cephalosporins especially cephazolin is 1Cephalosporins especially cephazolin is 1stst line line prophylactic agent for most surgical procedures prophylactic agent for most surgical procedures because of their low toxicity, long serum half life, because of their low toxicity, long serum half life, broad spectrum of activity, low cost. Third generation broad spectrum of activity, low cost. Third generation should not be used for routine prophylaxis because should not be used for routine prophylaxis because they promote the emergence of resistance.they promote the emergence of resistance.
Available antibioticsAvailable antibiotics
(In Wards)(In Wards) Inj AugmentinInj Augmentin Inj AmpicloxInj Ampiclox Inj FlagylInj Flagyl Inj CeftriaxoneInj Ceftriaxone Tab novidatTab novidat Inj CephradinInj Cephradin
(In Emergency)(In Emergency)Inj ceftriaxoneInj ceftriaxoneInj cefotaximeInj cefotaximeInj Benzyl penicillinInj Benzyl penicillinInj novidatInj novidatInj FlagylInj FlagylInj gentacinInj gentacinInj cephradineInj cephradine
ProcedureProcedure LikelyLikely
OrganismsOrganisms
RecommenRecommended drugded drug
AvailableAvailable AlternativeAlternative
CARDIO-CARDIO-THORACITHORACICC
STAPH STAPH AUREUS,AUREUS,STAPH,EPSTAPH,EPSTREPT,STREPT,
GRAM –GRAM –VE VE BACCILIBACCILI
CEFAZOLCEFAZOLIN,IN,
CEFAMACEFAMANDOLE,CNDOLE,CEFUROXIEFUROXIMEME
CEPHRACEPHRADINEDINE
CLINDACLINDAMYCIN,MYCIN,
VANCOMVANCOMYCINYCIN
Vascular Vascular
SurgerySurgery
Staph,Staph,
EnterococcEnterococcus,gram-ve us,gram-ve baccilibaccili
Cefazolin,Cefazolin,
CefuroximCefuroximee
CephradineCephradine ClindmyciClindmycinn
Head andHead and
Neck Neck
SurgerySurgery
Organism Organism
AreAre
Anerobes,Anerobes,
Staph Staph Aureus,Aureus,
Gram-veGram-ve
ClindamyClindamycin is cin is recomendrecomendeded
AvailableAvailable
Include Include
metrnidazmetrnidazole + ole + CephradiCephradinene
AltrnateAltrnate
CephazoliCephazolin+Metronn+Metronidazoleidazole
Urology Urology surgerysurgery
(high risk(high risk
Only)Only)
Diabetic,Diabetic,
CatheterizCatheterizeded
Gram-ve Gram-ve bacillibacilli
EnterococEnterococusus
CefazolinCefazolin CiprofloxCiprofloxacinacin
CiprofloxCiprofloxacin,acin,
GentamycGentamycinin
OrthopediOrthopedic surgeryc surgery
CommonCommon
OrganimsOrganims
11stst line line AvailableAvailable 22ndnd line line
1)Closed1)Closed
fracturefracture
Staph Staph aureus,aureus,
Staph epiStaph epiCefazolinCefazolin CephradiCephradi
neneClindamyClindamycincin
2) Open2) Open
fracturefracture
Staph,Staph,
Strept,Strept,
Gram-veGram-ve
Baccili,Baccili,
AnearobeAnearobess
CefazolinCefazolin+Gentcin+Gentcin
CephradiCephradin+Gentacn+Gentacinin
ClindamyClindamycin+ cin+
GentacinGentacin
AmputatiAmputationsons
ClostridiaClostridiaGram –veGram –ve
Bacili,Bacili,
Gram+veGram+ve
Other Other anerobesanerobes
MetronidMetronidazole+azole+
GentacinGentacin+Flucoxa+Flucoxacilincilin
AugmentiAugmentin+n+
GentacinGentacin+Metroni+Metronidazoledazole
GeneralGeneral
SurgerySurgery
GastoduoGastoduodenal,Esodenal,Esophagialphagial
(High risk (High risk only)only)
OrganismOrganism
Enteric Enteric Gram-veGram-ve
Bacilli,Bacilli,
Gram +veGram +ve
coccicocci
11stst line line
CephazoliCephazolinn
AvailableAvailable
CephradiCephradin,n,
AugmentiAugmentin+Gentacn+Gentacinin
22ndnd line line
ClindamyClindamycin+cin+
GentacinGentacin
Biliary Biliary
Tract Tract
SurgerySurgery
Enteric Enteric
Gram-veGram-ve
Bacilli,Bacilli,
CefotaxiCefotaxime single me single dose,dose,
CefazolinCefazolin
CefotaxiCefotaximeme
AppendicAppendicectomyectomy
EntericEnteric
Gram-veGram-ve
bacillibacilli
CefazolinCefazolin+Metroni+Metronidazoledazole
03doses 03doses in non in non perforatedperforated,5days in ,5days in perforatedperforated
CephradiCephradin+Metronn+Metronidazoleidazole
CefoxitinCefoxitin
ColonColon
SurgerySurgery
(Elective)(Elective)
Enteric Enteric
Gram-veGram-ve
Bacilli,Bacilli,
EnterococEnterococcus,cus,
AnaerobeAnaerobess
Oral Oral ProphylaxProphylaxisis
Oral Oral neomycinneomycin+erothroc+erothrocin base 1g in base 1g
Each Each at1300,14at1300,1400,2100hr00,2100hrs preops preop
I/V I/V CefazolinCefazolin+metroni+metronidazoledazole
I/vI/v
CefotaxiCefotaxime+ me+ metronidametronidazole One zole One dose or dose or gentacin+gentacin+metronidametronidazolezole
Oral Oral neomycinneomycin+metroni+metronidazoledazole
I/vI/v
AmpicilinAmpicilin+Gentaci+Gentacin+Metronn+Metronidazoleidazole
Non Non electiveelective
CefoxitinCefoxitin
1g preop+ 1g preop+
3 postop 3 postop doses 8 doses 8 hrlyhrly
LaproscoLaproscopicpic
CholecystCholecystectomyectomy
No No antibiotic antibiotic prophlaxiprophlaxis requireds required
Herial Herial repair repair without without meshmesh
No No prophylaxprophylaxis is requiredrequired
Repair Repair with with meshmesh
CefazolinCefazolin
Single Single dosedose
CephradiCephradinn
StrangulatStrangulated Herniaed Hernia
Anerobic Anerobic and and Gram-ve Gram-ve BacilliBacilli
CefoxitinCefoxitin
1g 8hrly1g 8hrly
CefotaxiCefotaxime+metrome+metronidazolenidazole
PenetratinPenetrating g abdominal abdominal traumatrauma
Enteric Enteric Gram-ve Gram-ve bacillibacilli
EnterocoEnterococcus,ccus,
AnaerobAnaerobeses
CefazolinCefazolin+metroni+metronidazoledazole
MetronidMetronidazole+Cefazole+Cefotaximeotaxime
MetronidMetronidazole+genazole+gentacintacin
Breast Breast
SurgerySurgery
AugmentiAugmentinn
Acute Acute
CholecystCholecystitusitus
Gram –veGram –ve
Bacilli+ABacilli+Anerobesnerobes
CiprofloxCiprofloxacin acin 500mg 500mg BD+MetrBD+Metronidazoleonidazole
400mg 400mg TDSTDS
Acute Acute
PancreatitPancreatitus(low us(low risk)risk)
High RiskHigh Risk
CefuroxiCefuroximeme
ImipenumImipenum
CefotaxiCefotaximeme
Antibiotics in pregnancyAntibiotics in pregnancy
Penicillin , Cephalosporin's and Erythromycin Penicillin , Cephalosporin's and Erythromycin are the drug of choice.are the drug of choice.
Quinolones, Tetracycline ,Streptomycin are Quinolones, Tetracycline ,Streptomycin are
contraindicatedcontraindicated
Amino glycosides , Metronidazole (except 1Amino glycosides , Metronidazole (except 1stst trimester) , Sulphonamides Can be taken when trimester) , Sulphonamides Can be taken when indicated.indicated.
Thank YouThank You
