The role of cephalosporins in surgical prophylaxis.
ABSTRACT Worldwide, cephalosporins are the most widely used antibiotics for surgical prophylaxis. These drugs are recommended for prophylaxis because of their good safety profile, excellent antimicrobial activity against most of the bacteria causing postoperative wound infection, satisfactory penetration into critical tissues and, most importantly, a strong track record of efficacy in clinical trials. There are still unresolved questions about the choice of cephalosporin and the timing and duration of administration. In vaginal hysterectomy, Caesarian section, and biliary tract surgery a single preoperative dose of any one of several cephalosporins has been used effectively. There are no apparent benefits in using a longer course for prophylaxis, nor for choosing a third-generation cephalosporin rather than a first- or second-generation cephalosporin. Several cephalosporins have been employed successfully in cardiac surgery, mostly in trials using a 24-48 h regimen. A recent study with a single preoperative dose of ceftriaxone has produced favourable results. In elective colorectal surgery definitive conclusions are difficult because of limited controlled studies. The best results have been achieved with an oral bowel preparation such as neomycin-erythromycin. Metronidazole, combined with another agent to suppress facultative bacteria, has also produced excellent reduction in wound infections. While it is not firmly established that a systemic cephalosporin contributes to the proven good effects of an oral bowel preparation, there is evidence that the choice of the cephalosporin should be based, in part, on its activity against anaerobic bacteria.
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ABSTRACT: Background: In spite of several available guidelines for the appropriate use of antimicrobials in perioperative patients, the fear of high morbidity and mortality associated with Intra-abdominal infections and Surgical Site Infections has led to misuse of antimicrobials in the perioperative period. Aims: This study was conducted to ascertain the antibiotic prescribing patterns of surgeons for treatment of intraabdominal infections and surgical prophylaxis and specifically assess the prescribing patterns of surgeons at Institutions with a Hospital Infection Control Committee (HICC). Setting and Design: Questionnaire survey at ASICON 2003. Materials and Methods: A survey was conducted among surgeons from all over India attending the conference to ascertain the prevalent prescribing trends for treatment of intraabdominal infections and surgical prophylaxis and the average duration of treatment. Surgeons were also requested to indicate the presence of a HICC. Results: 650 surgeons of the 700 asked, filled in the questionnaire legibly. It was observed that third/fourth generation cephalosporin plus an anti-anaerobic agent were preferred for treating intra-abdominal infections (84%) for an average duration of 6.38 + 2.2 days. For surgical prophylaxis, we found that 55% of the surgeons prescribed a single antibiotic for clean surgeries. A combination of two or three antimicrobial agents was preferred in clean contaminated (42.3%) and dirty (46.9%) surgeries respectively. Third generation cephalosporins were the commonly prescribed antibiotics (80%) for all surgeries. However, antibiotics were prescribed for durations longer than recommended in standard guidelines. Although 260 surgeons stated that their Institution had an HICC, this had no major impact on the prescribing trends. Conclusion: There is an urgent need to promote rational antimicrobial prescribing among surgeons and to formulate National guidelines for appropriate use of antibiotics in surgical practice.
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ABSTRACT: The value of antibiotic prophylaxis in abdominal hysterectomy was reviewed by meta-analysis. Two independent literature searches (1986-1988) yielded 150 relevant papers, however, only 17 (11.3%) papers met our inclusion criteria. The selected papers described prospective, randomized, blinded, placebo-controlled studies of patients undergoing elective abdominal hysterectomy. In 14 of 17 (82%) trials, first- or second-generation cephalosporins were used. Results pooled confirm that antibiotic prophylaxis will reduce infectious morbidity following elective abdominal hysterectomy. Hospital stay is little affected and significant levels of infectious morbidity remain.Pharmaceutisch Weekblad Scientific Edition 01/1991; 12(6A):296-8; discussion 299. DOI:10.1007/BF01967837
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ABSTRACT: A prospective, controlled and randomised trial was started to detect the effectivity of a "single-shot" antibiotic prophylaxis in thoracic surgery using cefuroxime. Therefore 200 unselected patients, consecutively scheduled for major thoracic surgery except endoscopic procedures or mediastinoscopy were enrolled in this study and randomized into either the control group (no antibiotics perioperatively; n = 100) or the prophylaxis group (one dose of 1.5 g cefuroxime i.v. at induction of anaesthesia; n = 100). Clinical signs correlated with infection, radiological findings and the results of repeated microbiological examinations were recorded and a comparative statistical analysis was done. Compared to controls the prophylaxis group had fewer (not significant) infections of the wound, the pleural cavity and the urinary tract and fewer patients of this group showed "pronounced infiltration" in daily taken chest roentgenograms (significant), clinical signs for pneumonia and pathologic sputum findings, or new bacterial colonisation of sputum specimens on the first postoperative day, whereas bacteria, isolated from tracheal aspirates, immediately taken after intubation disappeared more often. Specimens of pleural fluid taken postoperatively were less often positive for bacteria. Fewer patients were treated with antibiotics in the postoperative course and the courses were shorter in the prophylaxis group compared to controls. Considering the risk factor "positive microbiological culture" in preoperative tracheal aspirates, patients of the prophylaxis group showed much more seldom new radiological "infiltration" (statistically highly significant) and, in addition, had lower white blood cell counts (significant) and lower mean maximal body temperatures. The results of our trial confirm the preventive effect of "single-shot" antibiotic prophylaxis in thoracic surgery against infections.Infection 02/1993; 21 Suppl 1:S35-44. DOI:10.1007/BF01710342 · 2.86 Impact Factor