Surgical Antimicrobial Prophlaxis- Recent Guidelines
Antimicrobial prophylaxis controls the rate of surgical wound infections if used appropriately and adequately.
Before implementing the regimens, it is essential to understand the concept and rationale behind their usage. National Research Council (NRC) wound classification Criteria and Study of efficacy of Nosocomial Infection Control -SENIC risk factors help in identifying patients at risk of developing surgical wound infections and decide on prophylactic antibiotic administration.
Salient Principles of antimicrobial surgical prophylaxis:
The antibiotic should be active against common surgical wound pathogens; unnecessarily broad coverage should be avoided.
The shortest possible course -ideally a single dose of the most effective least toxic antibiotic should be used.
Choice of antibiotics for surgical prophylaxis:
As mentioned above, choice of antibiotic for surgical prophylaxis. The antibiotics recommended for surgical prophylaxis are as follows.
Cardiac, thoracic, vascular, neurosurgical, orthopedic, head & neck, gastroduodenal, biliary tract, hysterectomy and cesarean section require Cefazolin as antibiotic for surgical antimicrobial prophylaxis.
Elective colorectal procedures require oral erythromycin or neomycin.
Emergencies like obstruction etc. require cefoxitin, cefotetan or cefmetazole.
Appendicectomy requires cefoxitin, ceftizoxime, cefotetan or cefmetazole.
Timing Of Administration and Importance:
The timing of antibiotic antibiotic administration should be adjusted so that the antibiotic administered should exceed Minimum inhibitory concentration at the site of operation before incision and throughout the procedure.
Parenteral antibiotics should be administered sixty minutes before incision. If cesarean section is performed, the ideal time is after umbilical cord is clamped.
Non adherence to these principles leads to excesssive surgical wound infection rates.