Guidelines for antibiotic use : Guidelines for antibiotic use By Doctor Saleem
Holy Family Hospital Rawalpindi Surgical wound classificationaccording to contamination : Surgical wound classificationaccording 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 contaminated : Clean 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% Contaminated : Contaminated 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% Dirty : Dirty 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 Guidelines : Antibiotic Prophylaxis Guidelines A single preoperative dose of antibiotic is as effective as full five days course of therapy assuming uncomplicated procedure.
Prophylactic antibiotics should be administered within 1 hour prior to incision, preferably with induction of anesthesia.
Prophylatic antibiotics should target anticipated organisms. Contd; : Contd; Prophylaxis should not be extended beyond 24 hours following surgery.
One preoperative and two or three postoperative doses are sufficient in clean surgery.
Contaminated and dirty procedures should additionally receive additional postoperative coverage.
During prolonged procedures antibiotic prophylaxis should be readministered every 3 hours.
Use of antibiotic in procedures classified as contaminated or infected should be used as therapeutic and not prophylactic. Contd; : Contd; In traumatically injured patients antibiotics cannot be given before bacterial contamination occurs.
Cephalosporins especially cephazolin is 1st line prophylactic agent for most surgical procedures because of their low toxicity, long serum half life, broad spectrum of activity, low cost. Third generation should not be used for routine prophylaxis because they promote the emergence of resistance. Available antibiotics : Available antibiotics (In Wards)
Inj Cephradin Slide 10: (In Emergency)
Inj Benzyl penicillin
Inj cephradine Antibiotics in pregnancy : Antibiotics in pregnancy Penicillin , Cephalosporin's and Erythromycin are the drug of choice.
Quinolones, Tetracycline ,Streptomycin are
Amino glycosides , Metronidazole (except 1st trimester) , Sulphonamides Can be taken when indicated. Slide 22: Thank You