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Guidelines For Antibiotic Use by doctor Saleem

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Antibiotic guidelines in surgery,
especially antibiotic prophylaxis.
Prophylactic antibiotics in general surgery, cardiothoracic, vascular, orthopedic,neurosurgery,
Classification of wounds.
Guidelines of prophylactic antibiotics
By doctor Saleem

Publicado en: Salud y medicina

Guidelines For Antibiotic Use by doctor Saleem

  1. 1. Guidelines for antibiotic use By Doctor Saleem Holy Family Hospital Rawalpindi
  2. 2. Surgical wound classification according to contamination <ul><li>Clean: </li></ul><ul><li>Uninfected operative wound in which no inflammation is encountered and the respiratory, alimentary, genital, or infected urinary tract are not entered. Wounds are primarily closed and, if necessary, drained with closed drainage. </li></ul><ul><li>Infection rate 3.3% </li></ul>
  3. 3. Clean contaminated <ul><li>Operative wound in which the respiratory, alimentary, genital or urinary tracts are entered under controlled conditions and without unusual contamination </li></ul><ul><li>Infection rate 10.8% </li></ul>
  4. 4. Contaminated <ul><li>Open, fresh, accidental wounds. In addition, operations with major breaks in sterile technique or gross spillage from the gastrointestinal tract, and incisions in which acute, nonpurulent inflammation is encountered are included in this category </li></ul><ul><li>Infection rate 16.3% </li></ul>
  5. 5. Dirty <ul><li>Old traumatic wounds with retained devitalized tissue and those that involve existing clinical infection or perforated viscera. This definition suggests that the organisms causing postoperative infection were present in the operative field before the operation. </li></ul><ul><li>Infection rate 28.6% </li></ul>
  6. 6. Antibiotic Prophylaxis Guidelines <ul><li>A single preoperative dose of antibiotic is as effective as full five days course of therapy assuming uncomplicated procedure. </li></ul><ul><li>Prophylactic antibiotics should be administered within 1 hour prior to incision, preferably with induction of anesthesia. </li></ul><ul><li>Prophylatic antibiotics should target anticipated organisms. </li></ul>
  7. 7. Contd; <ul><li>Prophylaxis should not be extended beyond 24 hours following surgery. </li></ul><ul><li>One preoperative and two or three postoperative doses are sufficient in clean surgery. </li></ul><ul><li>Contaminated and dirty procedures should additionally receive additional postoperative coverage. </li></ul><ul><li>During prolonged procedures antibiotic prophylaxis should be readministered every 3 hours. </li></ul><ul><li>Use of antibiotic in procedures classified as contaminated or infected should be used as therapeutic and not prophylactic. </li></ul>
  8. 8. Contd; <ul><li>In traumatically injured patients antibiotics cannot be given before bacterial contamination occurs. </li></ul><ul><li>Cephalosporins especially cephazolin is 1 st line prophylactic agent for most surgical procedures because of their low toxicity, long serum half life, broad spectrum of activity, low cost. Third generation should not be used for routine prophylaxis because they promote the emergence of resistance. </li></ul>
  9. 9. Available antibiotics <ul><li>(In Wards) </li></ul><ul><li>Inj Augmentin </li></ul><ul><li>Inj Ampiclox </li></ul><ul><li>Inj Flagyl </li></ul><ul><li>Inj Ceftriaxone </li></ul><ul><li>Tab novidat </li></ul><ul><li>Inj Cephradin </li></ul>
  10. 10. <ul><li>(In Emergency) </li></ul><ul><li>Inj ceftriaxone </li></ul><ul><li>Inj cefotaxime </li></ul><ul><li>Inj Benzyl penicillin </li></ul><ul><li>Inj novidat </li></ul><ul><li>Inj Flagyl </li></ul><ul><li>Inj gentacin </li></ul><ul><li>Inj cephradine </li></ul>
  11. 11. CLINDAMYCIN, VANCOMYCIN CEFAZOLIN, CEFAMANDOLE,CEFUROXIME CEPHRADINE Clindmycin Cephradine Cefazolin, Cefuroxime Staph, Enterococcus,gram-ve baccili Vascular Surgery STAPH AUREUS,STAPH,EPSTREPT, GRAM –VE BACCILI CARDIO-THORACIC Alternative Available Recommended drug Likely Organisms Procedure
  12. 12. Ciprofloxacin, Gentamycin Ciprofloxacin Cefazolin Gram-ve bacilli Enterococus Urology surgery (high risk Only) Diabetic, Catheterized Altrnate Cephazolin+Metronidazole Available Include metrnidazole + Cephradine Clindamycin is recomended Organism Are Anerobes, Staph Aureus, Gram-ve Head and Neck Surgery
  13. 13. Clindamycin Cephradine Cefazolin Staph aureus, Staph epi 1)Closed fracture Clindamycin+ Gentacin Cephradin+Gentacin Cefazolin+Gentcin Staph, Strept, Gram-ve Baccili, Anearobes 2) Open fracture 2 nd line Available 1 st line Common Organims Orthopedic surgery
  14. 14. 2 nd line Clindamycin+ Gentacin Available Cephradin, Augmentin+Gentacin 1 st line Cephazolin Organism Enteric Gram-ve Bacilli, Gram +ve cocci General Surgery Gastoduodenal,Esophagial (High risk only) Augmentin+ Gentacin+Metronidazole Metronidazole+ Gentacin+Flucoxacilin ClostridiaGram –ve Bacili, Gram+ve Other anerobes Amputations
  15. 15. Cefoxitin Cephradin+Metronidazole Cefazolin+Metronidazole 03doses in non perforated,5days in perforated Enteric Gram-ve bacilli Appendicectomy Cefotaxime Cefotaxime single dose, Cefazolin Enteric Gram-ve Bacilli, Biliary Tract Surgery
  16. 16. Oral neomycin+metronidazole I/v Ampicilin+Gentacin+Metronidazole I/v Cefotaxime+ metronidazole One dose or gentacin+metronidazole Oral Prophylaxis Oral neomycin+erothrocin base 1g Each at1300,1400,2100hrs preop I/V Cefazolin+metronidazole Enteric Gram-ve Bacilli, Enterococcus, Anaerobes Colon Surgery (Elective)
  17. 17. No antibiotic prophlaxis required Laproscopic Cholecystectomy Cefoxitin 1g preop+ 3 postop doses 8 hrly Non elective
  18. 18. Cefotaxime+metronidazole Cefoxitin 1g 8hrly Anerobic and Gram-ve Bacilli Strangulated Hernia Cephradin Cefazolin Single dose Repair with mesh No prophylaxis required Herial repair without mesh
  19. 19. Augmentin Breast Surgery Metronidazole+gentacin Metronidazole+Cefotaxime Cefazolin+metronidazole Enteric Gram-ve bacilli Enterococcus, Anaerobes Penetrating abdominal trauma
  20. 20. Cefotaxime Cefuroxime Imipenum Acute Pancreatitus(low risk) High Risk Ciprofloxacin 500mg BD+Metronidazole 400mg TDS Gram –ve Bacilli+Anerobes Acute Cholecystitus
  21. 21. Antibiotics in pregnancy <ul><li>Penicillin , Cephalosporin's and Erythromycin are the drug of choice. </li></ul><ul><li>Quinolones, Tetracycline ,Streptomycin are </li></ul><ul><li>contraindicated </li></ul><ul><li>Amino glycosides , Metronidazole (except 1 st trimester) , Sulphonamides Can be taken when indicated. </li></ul>
  22. 22. <ul><li>Thank You </li></ul>