Prophylaxis of postoperative infections.
The antibiotic most appropriate for prophylaxis of postoperative infections depends on the nature of the operation. In aseptic (clean) operations, gram-positive postoperative infections are the primary concern, and cefazolin is recommended because of its excellent pharmacokinetics and good activity against gram-positive pathogens, including staphylococci. In those operations where violation of the digestive tract creates a contaminated field, a cefotaxime-generation cephalosporin is the agent of choice because of the excellent safety profiles and the capability of agents of this class to kill essentially all pathogenic gram-negative aerobes as well as a substantial portion of anaerobes. Selection of resistant bacteria has not been significant and is unlikely to become so with single-dose prophylaxis. Occasionally, if there is a high probability that the operative field may be heavily contaminated by anaerobes, metronidazole should be added. Dosing should be sufficient to cover the operative period. Only a single prophylactic dose is necessary, given at the time of induction of anesthesia. For particularly long operations, a second dose of those antibiotics with half-lives shorter than 60 min is required two hours after the first. Single-injection prophylaxis is effective, inexpensive, has no side effects and does not induce bacterial resistance.
Wittmann
D H
DH
Dept. of Surgery, Medical College of Wisconsin, Milwaukee 53226.
Condon
R E
RE
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001062:Appendectomy; D001662:Biliary Tract Surgical Procedures; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007422:Intestines / Q000601:surgery; D011292:Premedication; D013270:Stomach / Q000601:surgery; D013530:Surgical Wound Infection / Q000503:physiopathology / Q000517:prevention & control*; D013754:Tetracyclines / Q000008:administration & dosage / Q000627:therapeutic use; D014656:Vascular Surgical Procedures
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D013754:Tetracyclines