Antibiotics use is a prepared slide presentation by Dr. NTAMBARA KANYANGIRA Nelson, university of RWANDA, IN post graduate studies, Orthopedic surgery

1. ANTIBIOTICS USE IN SURGERY
PRESENTER: Dr. NTAMBARA KANYANGIRA Nelson
Surgical Resident PGY1
SUPERVISOR: Dr. MUTABAZI Emmanuel
Date: 19/06/2021

2. Outline
• INTRODUCTION
• GENERAL PRINCIPLES OF ANTIBIOTICS USE
• ANTIBIOTIC PROPHYLAXIS
• THERAPEUTIC ANTIBIOTIC USE
• INDISCRIMINATE USE OF ANTIBIOTICS
• TOXICITY OF ANTIBIOTICS
• CONCLUSIONS

3. Definition
Are products of various species of microorganisms including bacteria,
fungi and actinomycetes that suppress growth or kill other micro-
organisms
Antimicrobial (antibacterial) is a term use to including purely
synthetic agents such as:
• Sulphonamides
• Quinolones

4. Classification of antibiotics
1. Cell wall synthesis inhibitors
(inhibit Peptidoglycan synthesis)
B-Lactem- penicillins / cephalosporins
Others: Vancomycin/ bacitran
2. Protein synthesis inhibs.
( interfere with 50s or 30s of rRNA
Tetracycline, Aminoglycosides, macrolides,
Chloramphenicol, Clindamycin
3. Folate Antagonists ( Sulphonamides) inhibit folate
synthesis or reduction
Eg; Sulfamethoxazole, Trimethoprim
4. Quinolones
DNA gyrase inhibitors
Ciprofloxacin, Levofloxacin
5. Nitro-imidazole Eg; Metronidazole
6. RNA-Polymerase inhibitors Eg: Rifampicin

5. Mode of action
Bacteriocidal
• penicillins,
• Aminoglycoside
• Cephalosporin
• Metronidazole
• quinolones
Bacteriostatic
• Chloramphenicol
• Tetracyclines
• Macrolides
• Sulphonamide
• Clindamycin

6. General Principle of antibiotics use.
• Favorable outcome of surgeries are recorded due to appropriate use
of antibiotics.
• Prevention and treatment of infection is of great importance and
responsibility for surgical team.
• SSI increase mortality, morbidity, hospital stay and bulky bill.

7. Factors to base on while selecting ATB drug.
• Susciptible organisms depending
mostly on site of infection.
• Safety of the drug.
• Patient factors( age, pregnancy,
lactating, allergies, associated
illness..)
Drug
• availability
• Accessibility
• affordability

8. Prophylactic antibiotics in surgery.
Indications
 Wounds
• Clean contaminated and contaminated wound
• Clean wound in which implants or prosthesis are inserted
• Animal or Human bite
• Open fracture
• Delay to cleaning > 6hrs
• Foot/ Hand wounds
• Wound length > 5cm
• Crush
• Wound involving body cavity/ perineum
• Immuno-suppressed patient
• Burns

9. Overall considerations about prophylaxis
• It is not a substitute or alternative to aseptic practice and good surgical
technique.
• Necessary only in high-risk cases of bacterial contamination
• Pre-op selection of antibiotic should consider the normal flora in clean
cases and the likely contaminant in dirty cases
• It should be administered Intravenously 30-60mins before incision.
• Adoption of Policy on type antibiotics to use is crucial.

10. Normal flora
ANATOMICAL SITE NORMAL FLORA
Skin Staph, Strept., Propionibacteria
Oral cavity Above, Anaerobes, gram- rods
Nasopharynx Staph, strept, H. influenza and anaerobes
Thorax Staph, Strept, propionicateria
limbs Above
Oesophagus – jejunum Flora of nasopharynx + enterobacteriaecea
Large bowel Gram- rods, Enterococci & anaerobes
Female genital tract Flora of large gut, Staph, Strept, H. influenza
Urinary tract Normally sterile

11. Recommended Drugs for some procedures

12. Therapeutic Antibiotics
It is given to treat the already established infection
Considerations.
1. Establish a Clinical Diagnosis and the need for Antibiotics base on
history and physical examination
2. Determine the Urgency of the situation
• Non-urgent situation: mild infection or chronic infection
• Urgent situation:- Suspected severe infection

13. Cont’
3. Obtain an appropriate clinical specimens for examination, culture
and sensitivity
4. Remove barrier to cure by
- Debridement
- Sequestrectomy
- I & D
- Proper wound care

14. 5. Determine the most likely organism causing the infection
• Focus of infection
• Age
• Epidemiologic features
• Prior culture data
• 6. If multiple antibiotics are available to treat pathogen, choose the
best agent however in some cases combination can be considered to
achieve synergism

15. 8. Assessment of the effectiveness of chosen ATB
Clinical assessment
Temperature
Inflammatory markers e.g: CRP, ESR
Control culture results
9. Initial therapy may need modification after culture results are
available
• Modification not necessary if there is significant Relief of symptoms
• Narrow spectrum of antibiotics should be used (to decrease the risk
of colonization)
• Negative cultures

16. Danger of Indiscriminate use of antibiotics
• Development of drug resistance
• Alteration of individual and hospital bacterial ecology
• Higher cost of treatment
• Masking serious infection without eradicating it (e.g: abscess)
• Clearing of normal flora especially in GI

17. Adverse effects of commonly used ATBs
DRUGS COMMON OCCASIONAL
Penicillins Allergic reaction Anaphylaxis
Cephalosporins Thrombophlebitis, GI Symptoms
Aminoglycosides Nephrotoxicity
Erythromycin GI irritation
Clindamycin Diarrhea, rashes
levofloxacin Headache, dizziness, lightheadedness

18. Take Home Message
• Prophylactic and therapeutic use of antibiotics result into good
outcome
• Indiscriminate use of antibiotics should be prohibited
• Choose the antibiotics wisely.

19. References
• Michal halub; basic principles of antibiotic use, UH boluvka
• Titigah B. A, Antibiotic in surgery, www.authorstream.com 2010
• Richard A.H , Pamela C.C: Illustrated Reviews of pharmacology, 2nd
Edition. lippincott’s 2002
• Vanderpuye V. in principle and practice of medicine of surgery
including pathology in the tropics, 4th edition 2010.