Prophylactic Antibiotics In Surgery

Whenever surgeries are planned antibiotics are usually given to prevent the risk of wound infections which occurs in appx. 20% of GI surgeries. Prophylaxis is recommended for almost all clean or contaminated and dirty procedures.

Factors supporting the prophylaxis:There are certain patient related or procedure related factors that support the giving of antibiotics in order to prevent infection associated with the surgical procedure. These factors may include:

• Patients who have some valvular heart problem
• Immunocompromised patients.
• Too young or very old age.
• Procedures involving mouth, GI tract, GU tract and respiratory tract.

Timings Of antibiotic Administration:
It is important to give the antibiotic at a n appropriate time before the surgery in order to give the maximum benefit. The first dose is usually given before the surgery about 30 minutes before the incision. Re administration at one to two half live of the antibiotic is usually recommended.

Antibiotic Regimens: It depends upon personal and local preference but the usual recommendation is as follows:

• Biliary surgery: Cefuroxime 1.5 g for 1 dose IV + Metronidazole
• Appendectomy: If uncomplicated , a single dose of cefuroxime 1.5 g is effective
• Colorectal Surgery: Cefuroxime 1.5 g every 8 hrs + metronidazole 500 mg 8 hrly given for 1 – 3 doses IV
• Vascular surgery: Co-amoxiclav 1.2 g IV on induction, if penicillin allergic, give Cefuroxime 1.5 IV or IM + metronidazole 500 mg IV.

Anareobic cover is not always required. MRSA is an increasing concern so sometime prophylaxis with vancomycin may be given too.