The role of cephalosporins in surgical prophylaxis.

Department of Community Health and Medicine, Tufts University School of Medicine, Boston, MA 02111.
Journal of Antimicrobial Chemotherapy (Impact Factor: 5.44). 05/1989; 23 Suppl D:61-70. DOI: 10.1093/jac/23.suppl_D.61
Source: PubMed

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.

  • Source
    [Show abstract] [Hide abstract]
    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.
    Indian Journal of Surgery (ISSN: 0972-2068) Vol 67 Num 6.
  • [Show abstract] [Hide abstract]
    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.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective Assessing and monitoring care and service using clinical indicators (CIs) can allow the measurement of and lead to improvements in the quality of care. However, the management and maintenance of CI data has been shown to be difficult because the data are usually collected and provided manually. In this study, for the purpose of efficient managing quality indicators, a data warehouse (DW)-based CI monitoring system was developed. The clinical effectiveness and efficiency of a DW-based CI monitoring was investigated through several case studies of the system's operation at a tertiary hospital. Methods This study analyzed the CIs that have been developed over the past 8 years at a 1,340-bed tertiary general university hospital in South Korea to improve and monitor the quality of care and patient safety. The hospital was opened as a fully digital hospital in 2003, and the CIs were computerized in 2005 by implementing a DW-based CI monitoring system. We classified the computerized CIs and evaluated the monitoring results for several representative CIs, such as the optimal prescribing of preventive antibiotics, the average length of stay, the mortality rate, and the rehospitalization rate. Results During the development of the system in 2005, 12 of 19 CIs were computerized, and this number gradually increased until 299 of 335 CIs were computerized by 2012. In addition, among the CIs built computationally through the CI task force team, focal CIs subject to monitoring were selected annually, and the results of this monitoring were shared with all of the staff or the related department and its staff. By providing some examples of our CI monitoring results, we showed the feasibility of improving the quality of care, and maintaining the optimum level of patient care with less labor. Conclusions The results of this study provide evidence regarding the clinical effectiveness and efficiency as well as the systems operation experience of a DW-based CI monitoring system. These findings may aid medical institutions that plan on computerizing CIs with respect to decision and policy making regarding their systems development and operations.
    International Journal of Medical Informatics 07/2014; · 2.72 Impact Factor