Antibiotic Pearls for Surgical Prophylaxis

Study Notes

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.

Description

Learn the 10 key principles to consider when administering antibiotics for surgical prophylaxis, including timing, selection, and spectrum. Ensure effective antibiotic use and prevent surgical site infections.