Antibiotic prophylaxis

Antibiotic prophylaxis refers to the prevention of infection complications using antimicrobial therapy (most commonly antibiotics).

Even when sterile techniques are adhered to, surgical procedures can introduce bacteria and other microbes in the blood (causing bacteremia), which can colonize and infect different parts of the body. An estimated 5 to 10 percent of hospitalized patients undergoing otolaryngology ("head and neck") surgery acquire a nosocomial ("hospital") infection, which adds a substantial cost and an average of 4 extra days to the hospital stay.

Antibiotics can be effective in reducing the occurrence of such infections. Patients should be selected for prophylaxis if the medical condition or the surgical procedure is associated with a considerable risk of infection or if a postoperative infection would pose a serious hazard to the patient's recovery and well-being.^[1]

Microbial infections

Local wound infections (superficial or deep-sided), urinary tract infections (caused by a bladder catheter inserted for surgery), and pneumonia (due to impaired breathing/coughing, caused by sedation and analgesics during the first few hours of recovery) may endanger the health of patients after surgery. Visibly worse are postoperative bacterial infections at the site of implanted foreign bodies (sutures, ostheosynthetic material, joint replacements, pacemaker implants, etc.) Often, the outcome of the procedure may be put into question and the life of the patient may even be put at risk.

Prevention of microbial infection

Worldwide experience with antimicrobial prophylaxis in surgery has proven to be effective and cost-efficient, both avoiding severe patient suffering while saving lives (provided the appropriate antibiotics have been carefully chosen and used to the best of current medical knowledge).

Antibiotic selection

A proper regimen of antibiotics for perioperative prophylaxis of septic complications decreases the total amount of antimicrobials needed and eases the burden on hospitals. The choice of antibiotics should be made according to data on pharmacology, microbiology, clinical experience and economy. Drugs should be selected with a reasonable spectrum of activity against pathogens likely to be encountered, and antibiotics should be chosen with kinetics that will ensure adequate serum and tissue levels throughout the risk period.

For prophylaxis in surgery, only antibiotics with good tolerability should be used. Cephalosporins remain the preferred drugs for perioperative prophylaxis due to their low toxicity. Parenteral systemic antibiotics seem to be more appropriate than oral or topical antibiotics because the chosen antibiotics must reach high concentrations at all sites of danger. It is well recognized that broad-spectrum antibiotics are more likely to prevent gram-negative sepsis. New data demonstrate that third generation cephalosporins are more effective than first and second generation cephalosporins if all perioperative infectious complications are taken into consideration. Dermatologic surgeons commonly use antibiotic prophylaxis to prevent bacterial endocarditis. Based on previous studies, though, the risk of endocarditis following cutaneous surgery is low and thus the use of antibiotic prophylaxis is controversial. Although this practice is appropriate for high-risk patients when skin is contaminated, it is not recommended for noneroded, noninfected skin.^[2] There are many factors that affect physicians’ compliance with guideline recommendations, including cultural factors, educational background, training, nurse and pharmacist influences, medication supply, and logistics.[3]

Advantages of long-acting antibiotics

Long-acting, broad-spectrum antibiotics offer the following advantages by comparison to short-acting antimicrobials in perioperative prophylaxis:

• A single dose covers the whole perioperative risk period - even if the operation is delayed or long-lasting - and with regard to respiratory and urinary tract infections
• Repeat administrations for prophylaxis are not necessary, so that additional doses are less likely to be forgotten (an advantage of practical value in a busy working situation such as a hospital)
• Less risk of development of resistance and less side effects
• Increased compliance and reduced errors of administration
• Possibly better-effectiveness (less material and labor cost, less septic perioperative complications)

There are many factors that affect physicians’ compliance with guideline recommendations, including cultural factors, educational background, training, nurse and pharmacist influences, medication supply, and logistics.^[3]

References

Resources

• Antimicrobial Therapy in Otolaryngology Archived 11 December 2005 at the Wayback Machine.
• Guidelines for Antimicrobial Usage 2008-2009 Tables 29 - 31 from the Cleveland Clinic
• Antimicrobial prophylaxis Virginia-Maryland Regional College of Veterinary Medicine
• Disease Management Project Online Medical Reference from the Cleveland Clinic