8 Questions
What is the primary consideration for determining antibiotic prophylaxis?
National guidelines and local patterns of antibiotic sensitivity
In what circumstances may antibiotics not be indicated?
Low-risk, elective procedures without implants
What is the exception to penicillin allergy being a contraindication to cefazolin administration?
Documented history of anaphylaxis
When should an antibiotic infusion ideally be completed?
Before incision
What is the consideration when a tourniquet is used?
The dose should be completed at least 5 minutes before the tourniquet is inflated
Why are dosing schedules more frequent for antibiotic prophylaxis?
To maintain wound tissue levels throughout surgery and ongoing contamination
What is the consideration for additional intraoperative doses?
Significant blood loss
What should be recorded when antibiotics are not given?
The reason for not giving antibiotics
Study Notes
Antibiotic Prophylaxis Recommendations
- Antibiotic prophylaxis choices should be determined by a hospital committee considering national guidelines, local antibiotic sensitivity patterns, and other factors.
- Confirmation of antibiotic selection with surgeons should be done at the time-out or earlier, considering possible delays or exemptions (e.g., low-risk, elective procedures).
B-Lactam Allergies
- Penicillin allergy is rarely a contraindication to cefazolin or other cephalosporin administration.
- A documented history of serious reactions (e.g., anaphylaxis, angioedema, hives, bronchospasm, Stevens-Johnson syndrome, or toxic epidermal necrolysis) is an exception.
- The severity of a patient's B-lactam allergy should be determined before choosing an alternative antimicrobial.
Antibiotic Administration
- Ideally, antibiotic infusion should be completed before incision, but starting the infusion before incision is also considered adequate.
- Infusion should be initiated preoperatively for drugs requiring slow (>30 min) infusion.
- When a tourniquet is used, the dose should be completed at least 5 min before inflation.
Dosing Schedules
- Dosing schedules are more frequent than for therapeutic use to maintain wound tissue levels throughout surgery and ongoing contamination.
- Renal insufficiency may delay redosing, although the initial dose is usually not affected.
- Additional intraoperative doses should be given when there is significant blood loss (~ half to one blood volume).
Specific Situations
- When therapeutic antibiotics are given preoperatively for an infection or presumed infection, prophylactic antibiotics are not required.
- Each situation should be examined individually, considering coverage of skin flora and continuation of therapeutic antibiotics.
This quiz covers the general recommendations for antibiotic prophylaxis in surgical procedures, including the choice, dose, and timing of antibiotics based on national guidelines and local antibiotic sensitivity patterns.
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