This document provides an overview of antibiotics used in surgical practice. It discusses the historical development of antibiotics and their classification. It covers principles of antibiotic prophylaxis for surgery, including timing, choice and administration of antibiotics. It also discusses therapeutic antibiotics for surgical infections, emphasizing rational choice and combination therapy. Commonly used antibiotics for various surgical procedures are outlined. The document raises some concerns about increasing antibiotic resistance and provides high-level descriptions of developing hospital antibiotic policies.
2. Table Of Contents
❖Historical Overview
❖Antibiotics And Its Classification In Brief
❖Surgical antibiotic prophylaxis ,its principles, choice & administration
❖Therapeutic antibiotics in surgery, its principles ,rationale & choice
❖Commonly used antibiotics in surgery
❖Antibiotic in pregnancy
❖Antibiotic resistance
❖Development of Antibiotic Policy
3. Historical Overview
❖Nineteenth century - Koch’s postulates Published by Robert Koch
❖Twentith century - Introduction of the principle of Aseptic
Surgery(carbolic acid) By Joseph Lister
❖Alexander fleming discovered Penicillin in 1928.
❖Antibiotic remain the mainstay of antimicrobial therapy that makes
many surgeries possible today.
7. Principles Of Surgical Antibiotic Prophylaxis
❖Should be administered for Operative Procedures that are associated
with high risk of infection
▪ Not required in Clean Surgery unless associated with Prosthesis is implanted
❖Use antibiotic that are effective against expected pathogen within
the hospital guidelines
❖Shortest possible course (ideally single dose)
8. ❖Antibiotic Should be delivered to operative site before Contamination
occurs
▪ i.e Within Decisive period.
❖Repeat dose during long operation or excessive blood loss
❖Patient with heart valve disease or prosthesis should be protected
with prophylactic antibiotics from bacteremia caused by Dental
work,Urethral Instrumentation or Visceral surgery
9. Administration
of Prophylactic
Antibiotics
Timing :
• within decisive period
• 30-60 mins before surgical incision is
recommended
• single shot iv administration at Induction of
anesthesia
Route :
• IV usually
Dose :
• Depends on weight
• Single dose
• Duration –should be <24 hr
11. Choice of
Antibiotics
For
Prophylaxis
❖Empirical Cover Against expected pathogens
within local Hospital Guidelines
➢Depends On
▪ Site & Type of surgery
✓ Orthopaedics (staph. Aureus /epidermidis) –
Flucloxacillin/Co-amoxiclav
✓ Abdominal , Colorectal and Bowel surgery –
cephalosporin +metronidazole
✓ Intraabdominal abscess-
Cephalosporin+metronidazole+Amikacin
✓ Urological (gram –ve) – Amikacin , nitrofurantoin
✓ Breast Surgery –CoAmoxiclav/ceftriaxone/ceftazidime
✓Antibiotic allergy
14. Rational
Use Of
Antibiotics
• Patient receive medication
Appropriate to their Clinical needs
in doses that meet their own
individual requirements for an
adequate period of time at the
lowest cost to them and their
community (WHO)
15. Choice Of
Antibiotic
Make a dx defining:
• Site of infection
• Type Of Organism responsible
• Antibiotic Sensitivity
Select the best drug
Considering :
• Sensitivity , Pharmacokinetic Factor
,optimum dose , Frequency , Route ,
Duration & Patient Factors
17. Therapeutic Antibiotics
❖Empiric Therapy :
➢Antibiotics to treat a clinically suspected infection before microbiological
cause is known
➢Should cover range of pathogen
➢Most appropriate Broad spectrum Antibiotics
❖Targeted therapy / Directed Therapy :
➢Antibiotic to treat bacteriologically confirmed infection
➢“Start Smart – then Focus” is the principle of Converting from Empiric
Therapy to Narrow Spectrum Directed therapy
18. Combination Therapy
• Polymicrobial infection :
➢Several Bacteria Suspected,Acting in Synergy
▪ Opening of Perforated/Ischaemic Bowel
✓Meropenem (for aerobic) &
Metronidazole (for anaerobic)
✓Alternatively Triple Therapy(Amoxicillin, Gentamicin & Metronidazole)
• To increase Clinical Efectiveness
✓E.g Biofilm Infection , elderly patient
• To reduce Development of antimicrobial resistance
24. Spread Of Antibiotic Resistance
❖From Person to Person
➢By Transfer of resistant bacteria between people
❖From Bacteria to Bacteria :
➢By transfer of resistance genes between bacteria
,usually on Plasmids
❖From Plasmid to plasmid
➢By transfer of resistance genes between genetic
elements within the bacteria , on Transposons
28. Antibiogram
Overall profile of antimicrobial susceptibility testing
results of a specific microorganism to a battery of
antimicrobial drugs
Aggregate data from Hospital
Only results for antimicrobial drugs that are
routinely tested & clinically useful should be
presented to clinicians
Helps Clinicians Selecting the best empiric
antimicrobial Rx in the event of pending
microbiology culture and susceptibility test.
