Antibiotic Pearls for Surgical Prophylaxis

Antibiotic Administration for Surgical Prophylaxis

• Administer antibiotics within 60 minutes before surgical incision to ensure adequate drug levels at the surgical site.
• Choose antibiotics based on local guidelines, considering the most common pathogens associated with the specific surgical procedure.
• Use antibiotics with a narrow spectrum of activity whenever possible to minimize the risk of developing antibiotic resistance.
• Administer antibiotics at the appropriate dose based on patient weight, renal function, and the specific antibiotic being used.
• Re-dose antibiotics during prolonged surgeries or those with excessive blood loss to maintain therapeutic levels throughout the procedure.
• Assess patient allergies to antibiotics and ensure alternative agents are used when necessary to avoid allergic reactions.
• Limit the duration of prophylactic antibiotic therapy to the perioperative period only, typically less than 24 hours, unless specific circumstances warrant an extended course.
• Tailor antibiotic selection to address the unique requirements of specific surgical sites, such as neurosurgery, cardiac surgery, or orthopedic procedures.
• Communicate and collaborate with the surgical team, infectious disease specialists, and microbiology services to optimize antibiotic selection and ensure appropriate prophylaxis.
• Accurately document the administration of prophylactic antibiotics, including the time of administration, drug name, dose, and any relevant patient-specific factors or considerations.

Antibiotic-Specific Considerations

• Ciprofloxacin can increase the risk of Achilles tendon rupture (Quinolone exposure 4.3%).
• The primary adverse effect of IV clindamycin is pseudomembranous colitis.
• Neomycin is given orally to prevent nephrotoxicity.
• Ciprofloxacin and Vancomycin require prolonged infusion time, and consideration should be given to ensure infusion of 60 minutes is finished within 60 minutes of incision.
• Aminoglycosides, Vancomycin, and other antibiotics should be used cautiously in the presence of renal failure.
• In general, most drugs can be used safely in cirrhosis, but lower doses or reduced dosing frequency are often recommended due to altered pharmacokinetics.
• Aminoglycosides possess neuromuscular blocking activity, and Gentamicin or a combination of Gentamicin and clindamycin enhances rocuronium-induced neuromuscular blockade.

Miscellanea

• Antibiotics can be used to prevent surgical site infections while minimizing the risk of antibiotic resistance and adverse reactions.
• Antibiograms are tables showing how susceptible a series of microbes are to various antimicrobials.