antibiotics in surgery 2003
TRANSCRIPT
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PRESENTED BY :DR. SARAH AZAM
M.O SU1
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ANTIBIOTICS IN SURGERY PROPHYLAXIS
TREATMENT
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ANTIBIOTIC PROPHYLAXIS Fundamental principles of
Surgical Prophylaxis The antibiotic must be in the tissue
before the bacteria are introduced.
There is no data to support more than asingle dose. Further doses generallyconstitute treatment.
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ANTIBIOTIC
PROPHYLAXIS(CONTD.)
The chosen antibiotics must be active against
the most common expected pathogens. High risk patients generally warrant antibiotic
prophylaxis.
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or w c ype ooperations?
All clean-contaminated procedures.
Clean operations with foreign body implant.
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For which type ofoperations?(contd.)
used as treatment when:
contaminated or dirty/infected
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m ng o an o cprophylaxis
Current recommendations are that theparenteral antibiotics used in prophylaxisshould be given in sufficient dosage within 30minutes preceding incision.
the current recommendation is to administera second dose only if the operation lasts forlonger than 2 - 3 hours.
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of prophylacticantibiotics
Intravenous administration of the prophylactic
antibiotic is preferred for most patientsundergoing an operative procedure.
Oral antibiotics currently play a major role
only in the preparation of patients beforeelective colon surgery
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PENETRATION OF
TISSUESDrug must penetrate to the site of infection
CSF ; meningitis
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WHICH DRUGS DO NOT
PENETRATE BODY BARRIERS
Penicillins
CephalosporinsBeta lactamaseinhibitors
Polymixins
Aminoglycosides
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Cross cellular barriers very
readilySulphonamides
Macrolides
TetracyclinesChloramphenicol
FluoroquinolonesMetronidazole
Rifampin
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How does resistance work?
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How does resistance work?
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:PULMONARY,
OESOPHAGEAL 1st generation cephalosporins e.g.
cefazolin 1 - 2 g pre-induction
OR
2nd generation cephalosporins e.g.cefuroxime 1,5 g IV.
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Limb amputation 1st generation cephalosporins eg.
cefazolin 1 - 2 g IV.
OR
cefoxitin 2 g IV.
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GASTRODUODENAL
SURGERY Antibiotics are indicated in high riskpatients only, i.e. patients with bleeding ulcer,obstructive duodenal ulcer, gastric ulcer,decreased GI motility.
1st generation cephalosporins e.g.cefazolin 1 g IV pre-op.
For beta-lactam allergy, gentamicin 120mg plus clindamicin 600 mg IV preop.
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BILIARY TRACT
SURGERY Achieving adequate drainage will
prevent post-procedural cholangitis or sepsis
and there is no further benefit fromprophylactic antibiotics.
Cephalosporins are not active against the
enterococci, yet are clinically effective asprophylaxis in biliary surgery.
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BILIARY TRACT
SURGERY(contd.)With cholangitis, treat as infection, notprophylaxis. High risk patients include those>70 years of age, acute cholecystitis, non-
functioning gall-bladder, obstructive jaundiceor common duct stones.
1st generation cephalosporins e.g.cefazolin 2 g pre-op as a single dose
OR
cefoxitin 2 g pre-op as a single dose.
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INGUINAL HERNIA
REPAIR
Routine use is not recommended. For amesh implant, give prophylaxis e.g. 1stgeneration cephalosporin as a single dose.
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COLON SURGERY Recommended approach for preoperative
preparation before elective colon surgery and
terminal ileal surgery.
Second day prior to surgery Dietary restriction .
Magnesium sulphate, 30 ml of a 50%solution (15 g) orally at 10h00, 14h00 and18h00. In the evening, enemas until clear
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COLON
SURGERY(contd.)PREOPERATIVE DAY
Clear liquid diet, IV fluids as needed.
Magnesium sulphate in dosage as aboveat 10h00 and 14h00.
Neomycin and erythromycin base, 1 geach orally at 13h00, 14h00 and 23h00.Alternative oral antibiotics includemetronidazole plus kanamycin or neomycin.
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COLON
SURGERY(contd.) Day of surgery Cefoxitin 2 g pre-op and every 6 hours for 3doses OR
Metronidazole 500 mg IV pre-op single dose
OR Ampicillin plus metronidazole plus
aminoglycoside all as single doses
OR
3rd generation cephalosporin plusmetronidazole as a single dose
OR for patients with beta-lactam allergy, give
metronidazole 500 mg IV and gentamicin 3 mg/kg
IV pre-operatively, both as single doses.
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COLON
SURGERY(contd.)For non-elective colorectal surgery,
Cefoxitin 1 g IV pre-operatively andthen 1 g 8 hourly for 3 doses
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APPENDICECTOMY
Cefoxitin 2 g IV pre-op and for up to 3doses. If perforated, continue for 3 - 5 days.
For patients with beta-lactam allergy,give metronidazole 500 mg IV pre-operatively.
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PENETRATING
ABDOMINAL TRAUMA Any antibiotic cover can be considered astreatment and not as prophylaxis.
Cefoxitin 2 g IV on admission, continue
q.i.d. for 2 - 5 days for intestinal perforationOR
Metronidazole 500 mg IV and gentamicin1.7 mg/kg IV.
NOT INVOLVING A
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NOT INVOLVING AVISCUS
Recommendations for prophylaxis not available
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UROLOGICAL SURGERYProstatectomyProphylaxis only in high risk patients.
quinolones as a single oral pre-operative dose e.g. ciprofloxacin 500 mg POstat
OR
aminoglycosides as a single IV pre-operative dose
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UROLOGICAL SURGERY(contd.)
Transrectal prostatebiopsy
The quinolones have been shown toreduce bacteraemia from 37% to 7%.
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UROLOGICAL
SURGERY(contd.) Prophylaxis is supported if catheter has
been present for > 24 hours.
Ideally the catheter should be insertedtwo hours or less, prior to surgery.
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UROLOGICAL SURGERY(contd.)Dilatation of urethra, endoscopic diagnostic
procedures, needle biopsy or lithotripsy withsterile urine: prophylactic antibiotics are not
indicated.
Antimicrobials are not recommended prior tourological procedures in patients with sterileurine.
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UROLOGICAL
SURGERY(contd.)
If the urine is infected, it is preferable to
sterilize it before beginning an electiveprocedure.
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HEAD AND NECK
SURGERYIf incision is through oral or oropharyngeal
mucosa:
a. Cefazolin 2 g IV as single doseOR
b. amoxycillin-clavulanate IV 1,2 g as singledose
OR
c. gentamicin 80mg PLUS clindamycin600mg IV as single doses
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SURGICAL SEPSIS(purulent
infections)
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SKIN INFECTIONSBoilsStyes
CarbunclesAntibiotic therapy is usually not indicated
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SKIN
INFECTIONS(continued)Antibiotic therapy is indicated when
boils on face; cavernous sinus thrombosismay result
Immunocompromised patients
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CELLULITISSpreading infection of subcutaneous tissuesAcute pyogenic cellulitis;
Cause is S.PyogenesTreated by Penicillins
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CELLULITIS(contd.)
Anaerobic cellulitisSynergistic infection with both aerobes and
anaerobes.
Treat with penicillin.
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Thanks