title: Considerations of antibiotic prophylaxis in nonsurgical high risk patients.
abstract: Among patients in general hospitals approximately one-third receive antimicrobial drugs, and nosocomial infections develop in 3 to 4 percent of them. These two events vary widely suggesting no constant relation, except that antibiotic use affects the etiology and course of nosocomial infections. There is deliberation about the benefits versus the harm of antibiotic prophylaxis. It avoids the morbidity and tissue damage from infection with the least antibiotic for the shortest time and works best when the need is brief or the microbial target is a single species. Among nonsurgical patients, a high risk of infection results from exposure to a transmissible infection, minor procedural trauma or increased host susceptibility. In clinical use, antimicrobial prophylaxis usually combines inefficiency with unproved efficacy. Prevention of nosocomial acquisition of urinary tract infection, pneumonia, catheter sepsis and cutaneous infections by antibiotic prophylaxis is ineffective. Recommendations in other conditions are derived mostly from presumed benefit, recognized failures and assessment of adverse results from drug use. Inefficient long-term prophylaxis contributes to the emergence of transmissible bacterial drug resistance. Those clinical conditions that represent need with reasonable efficiency and those that are useless and dangerous prophylactic practices should be defined. Using one and avoiding the other through education and professional discipline offers the best hope of amplifying effective antibiotic prophylaxis and minimizing unwanted effects on the recipient and hospital cohorts.
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003428:Cross Infection / Q000517:prevention & control*; D004352:Drug Resistance, Microbial; D006801:Humans; D012306:Risk
chemical_list: D000900:Anti-Bacterial Agents