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Questions and Answers
What is the primary purpose of administering antibiotics before surgery?
What is the primary purpose of administering antibiotics before surgery?
- To prevent a surgical-site infection (SSI) (correct)
- To enhance wound healing
- To reduce the duration of surgery
- To improve blood flow to the area
Lipophilic antibiotics are preferred for crossing blood-brain barriers in certain infections.
Lipophilic antibiotics are preferred for crossing blood-brain barriers in certain infections.
True (A)
What is the recommended time frame for administering prophylactic antibiotics before a surgical incision?
What is the recommended time frame for administering prophylactic antibiotics before a surgical incision?
15-60 minutes before the incision
Antibiotic dosing should maintain concentrations above the MIC for the duration of the __________.
Antibiotic dosing should maintain concentrations above the MIC for the duration of the __________.
Which antibiotic is generally preferred for surgical prophylaxis due to its effectiveness against gram-positive coverage?
Which antibiotic is generally preferred for surgical prophylaxis due to its effectiveness against gram-positive coverage?
Match the antibiotic class to its primary characteristic:
Match the antibiotic class to its primary characteristic:
Continuation of antimicrobial prophylaxis beyond wound closure is beneficial.
Continuation of antimicrobial prophylaxis beyond wound closure is beneficial.
In cases where broader gram-negative and anaerobic coverage is desired, which antibiotics are appropriate?
In cases where broader gram-negative and anaerobic coverage is desired, which antibiotics are appropriate?
If an operation exceeds two half-lives of the selected antibiotic, an additional dose should be __________.
If an operation exceeds two half-lives of the selected antibiotic, an additional dose should be __________.
What factor is NOT considered when selecting an antibiotic for patients undergoing surgery?
What factor is NOT considered when selecting an antibiotic for patients undergoing surgery?
What is the primary consideration for confirming the presence of bacterial infection?
What is the primary consideration for confirming the presence of bacterial infection?
Fever is always present in patients with bacterial infections.
Fever is always present in patients with bacterial infections.
What are the five rights (5Rs) that health care providers should be aware of before prescribing antibiotics?
What are the five rights (5Rs) that health care providers should be aware of before prescribing antibiotics?
The use of __________ may lead to gray baby syndrome in neonates.
The use of __________ may lead to gray baby syndrome in neonates.
Match the following antibiotics with their potential adverse effects:
Match the following antibiotics with their potential adverse effects:
Which type of infections is empiric antibiotic therapy crucial?
Which type of infections is empiric antibiotic therapy crucial?
All antibiotics can cross the placenta and cause adverse effects to the fetus.
All antibiotics can cross the placenta and cause adverse effects to the fetus.
What must be sampled and cultured before starting antibiotic treatment?
What must be sampled and cultured before starting antibiotic treatment?
Neutropenic patients require __________ therapy to prevent fatal outcomes.
Neutropenic patients require __________ therapy to prevent fatal outcomes.
Which of the following antibiotic classes is known for causing renal toxicity in older patients?
Which of the following antibiotic classes is known for causing renal toxicity in older patients?
What is one of the five rights (5Rs) of antibiotic prescribing?
What is one of the five rights (5Rs) of antibiotic prescribing?
Fever is always present in patients with bacterial infections.
Fever is always present in patients with bacterial infections.
What should be sampled and cultured before initiating antibiotic treatment?
What should be sampled and cultured before initiating antibiotic treatment?
The use of __________ in neonates can lead to gray baby syndrome.
The use of __________ in neonates can lead to gray baby syndrome.
Match the following patient factors with their corresponding effects of antibiotic use:
Match the following patient factors with their corresponding effects of antibiotic use:
In which situation is empirical antibiotic therapy necessary?
In which situation is empirical antibiotic therapy necessary?
All antibiotics are safe to use during pregnancy.
All antibiotics are safe to use during pregnancy.
What are the parameters to confirm the presence of bacterial infection?
What are the parameters to confirm the presence of bacterial infection?
Bacterial infections are typically associated with elevated __________ counts.
Bacterial infections are typically associated with elevated __________ counts.
What consequence can result from using sulfonamides in growing children?
What consequence can result from using sulfonamides in growing children?
What is the principle behind concentration-dependent killing of antibiotics?
What is the principle behind concentration-dependent killing of antibiotics?
Antibiotics should only be given when necessary and after susceptibility testing where possible.
Antibiotics should only be given when necessary and after susceptibility testing where possible.
Which antibiotic class is preferred for surgical prophylaxis to provide gram-positive coverage?
Which antibiotic class is preferred for surgical prophylaxis to provide gram-positive coverage?
Antibiotics administered more than _______ hours after the first incision are unlikely to prevent surgical site infections.
Antibiotics administered more than _______ hours after the first incision are unlikely to prevent surgical site infections.
Match the antibiotic with its corresponding characteristic.
Match the antibiotic with its corresponding characteristic.
What should be monitored when selecting the appropriate dose of antibiotics?
What should be monitored when selecting the appropriate dose of antibiotics?
Surgical antimicrobial prophylaxis should always exceed 24 hours after wound closure.
Surgical antimicrobial prophylaxis should always exceed 24 hours after wound closure.
What is the primary goal of administering prophylactic antibiotics?
What is the primary goal of administering prophylactic antibiotics?
In serious infections, it is better to start with a __________ loading dose of bactericidal agents.
In serious infections, it is better to start with a __________ loading dose of bactericidal agents.
When should repeat doses of antibiotics be administered during surgery?
When should repeat doses of antibiotics be administered during surgery?
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Study Notes
Surgical Antibiotic Prophylaxis
- Definition: Antibiotics given before contamination of previously uninfected tissues or fluids to prevent surgical-site infection (SSI).
- Goal: Prevent SSI.
Microbiology
- Surgical antibiotic choice depends on the type of procedure, likely pathogens, and the antimicrobial’s safety and efficacy.
- Gram-positive coverage is typically included due to common skin flora like S.aureus and Staphylococcus epidermidis.
- First-generation cephalosporins (like cefazolin) are preferred for gram-positive coverage.
- If broader coverage is needed (gram-negative and anaerobic), cefoxitin or cefotetan are options.
Principles of Antimicrobial Prophylaxis
Route of Administration
- Intravenous (IV) is preferred for reliable serum and tissue concentrations.
- Intramuscular (IM) is another option.
- Oral administration is used for some bowel operations.
- Non-absorbable compounds (erythromycin base and neomycin) can be given orally up to 24 hours before surgery to cleanse the bowel.
Timing of First Dose
- Start infusing antibiotics within 60 minutes of the first incision.
- Single dose should be administered within 30 minutes to one hour before incision.
- Exceptions: fluoroquinolones and vancomycin can be infused 120 minutes prior to avoid infusion-related reactions.
Dosing and Redosing
- Goal is to maintain antibiotic concentrations above the MIC (minimum inhibitory concentration) of suspected organisms during surgery.
- If surgery exceeds two half-lives of the antibiotic, another dose should be administered.
- Repeat dosing lowers SSI rates (e.g., cefazolin has a 2-hour half-life, another dose is needed after 4 hours).
Duration
- Prophylaxis beyond wound closure is unnecessary.
- Studies show no benefit in continuing prophylaxis beyond 24 hours.
Surgical Antibiotic Prophylaxis
- Administered before contamination of uninfected tissues or fluids
- Goal is to prevent surgical-site infection (SSI)
Principles of Antimicrobial Prophylaxis
- Route of Administration: IV preferred for predictable serum and tissue concentrations, oral used for bowel operations
- Timing of First Dose: Infusion within 60 minutes of the first incision, single dose within 30-60 minutes before incision
- Dosing and Redosing: Maintain antibiotic concentrations above the MIC, repeat dose if operation exceeds two half-lives (e.g., cefazolin - every 4 hours)
- Duration: Continuation beyond wound closure is unnecessary, duration should not exceed 24 hours
Selecting the Right Antibiotic
- Microbiology: Choice depends on surgical procedure, likely pathogens, safety, and efficacy
- Gram-Positive Coverage: First-generation cephalosporins (cefazolin) are preferred
- Broader Coverage: Cefoxitin or cefotetan for gram-negative and anaerobic coverage
Selecting the Right Dose & Duration
- Concentration-Dependent Killing: e.g., aminoglycosides
- Time-Dependent Killing: e.g., beta-lactams, macrolides, clindamycin, linzolid
- Post Antibiotic Effect (PAE): Persistent bacterial suppression after antibiotic levels drop, e.g., aminoglycosides, azithromycin
General Principles of Therapy with Antibiotics
- Give only when necessary and after susceptibility testing
- Consider patient's hepatic and renal function in drug selection
- Start with parenteral loading dose of bactericidal agent to avoid resistance
- Continue for 3 days after apparent cure to prevent relapse
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