For MBBS SURGERY STUDENTS

1. by
Dr. Neeraj Kumar Jain
Deptt. Of Surgery
Principle of Antibiotics Use
in Surgery

2. Outline
INTRODUCTION
GENERALPRINCIPLES OF ANTIBIOTICS USE
ANTIBIOTIC PROPHYLAXIS
THERAPEUTIC ANTIBIOTIC USE
INDISCRIMINATE USE OF ANTIBIOTICS
TOXICITY OF ANTIBIOTICS
CONCLUSIONS

3. Introduction
Definition
Antibiotics; Are products of various species of micro-
organisms 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. Historical Background
- Louis Pasteur and Robert Koch 1877
- In 1928,Alexander Fleming
- Selman Waksman, in 1942
- 1960’s MILESAND BURKE

5. Classification of
antibiotics

6. Group/mechanism of Action
1-Cell wall synthesis inhibitors
(inh. Peptidoglycan synthesis)
B-lactem- Penicillins/cephalosporins
others- vancomycin/ bacitracin
2- Protein synthesis inhibitors
(interfere with 50s or 30s of rRNA)
Tetracyclines , Aminoglycoside ,
Macrolytes,chloramphenicol
clindamycin
3- Folate Antagonists (Sulphonamides)
Inhibitor folate synthesis or reduction
eg sulfamethoxazole, Trimethoprim
4- Quinolones
DNA gyrase inhibitors
eg ciprofloxacin, levofloxacin
5- Nitroimidazole Eg metronidazole
6-RNA polymerase inhibitor eg Rifampicin

7. Mode of action
bacteriostatic
Chloramphenicol
tetracyclines
macrolides
Sulphonamide
clindamycin
bactericidal
penicillins,
Aminoglycoside
Cephalosporin
Metronidazole
quinolones

8. Base on Spectrum of activity
- Narrow spectrum
- Extended spectrum
- Broad spectrum

10. JUSTIFICATION :
Treatment and prevention of infection is a cardinal
responsibility of thesurgical team.
Favorable outcome of surgeries were recorded with
appropriate useof antibiotics
SSI increase mortality, morbidity, hospital stay and
cost of treatment

11. Selection of antibiotics
Requires knowledge of
- The organism's identity and its sensitivity to a
particular agent
- The site of the infection (CNS, bone, GI, UT )

12. - The safety of the agent
- Patient factors (age, preg., lactation, sys.illnesses,
hypersensitivity)
- Availability, Accessibility, Affordability of the Drug

13. is the use of antibiotic to prevent anticipated
infection.

14. Indications for prophylaxis in surgery
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

15. General considerations
Not a substitute or alternative to aseptic practice and
good surgical technique.
Necessary only in high-risk cases of bacterial
contamination
Preop selection of antibiotic should consider the
normal flora in clean cases and the likely contaminant
in dirtycases
Adoption of Policy on type antibiotics to use is
Important

16. Anatomical site Normal flora
Skin Staphylococcus, streptococcus
propionibacteria
Oral cavity Above, anaerobes & gram negative
rods
Nasopharynx Staph., strept., H. influenzae and anaerobes
Thorax Staph, strept, and propionibacteria
Oesophagus - jejunum Flora of nasopharynx +
enterobacteriaecea
Large bowel Gram –ve rods, enterococci &
anaerobes
Female genital tract Flora of large bowel, staph strept, &
H. influenzae
Urinary tract Normally sterile
Limbs Staph, strept, propionibacteria

17. Recommended drugs for some
procedures

18. Periop
- It should start with premedication
- Should be administer 30min- 1hr before the surgery
- Should be intravenous
- Aiming at a saturated tissue concentration above MIC
at the time of surgery or manipulation.
- Re-administer at 1-2 t½ of the antibiotics for prolonged
surgery
- 24-48 hr is as effective as administration for 7days

19. Therapeutic antibiotics is given to fight infection that
is already established.

20. 1. Establish a Clinical Diagnosis and the need for
Antibiotics base on history and physical examination

21. 2 - Determine the Urgency of the situation
Non-urgent situation: mild infection or chronic
infection
Urgent situation:- Suspected severe infection

22. 3. Obtain an appropriate clinical specimens for
examination, culture and sensitivity
4. Remove barrier to cure by
- Debridement
- Sequstrectomy
- I &D
- Good wound care

23. 5. Determine the most likely organism causing the
infection
Focus of infection
Age
Epidemiologic features
Prior culturedata

24. 6. If multiple antibiotics are available to treat pathogen,
choose the best agent
Prior antibiotic allergies
Antibiotic penetration
Potential side effects
Medical condition of thepatient

25. 7- Antibiotic combination can be considered to achieve
Synergism

26. 8. Assess effectiveness of antibiotic therapy
- Clinical assessment –
↓ temperature - 48 hrs 4 BC antibiotics
3 - 4 days 4BS drugs
- Inflammatorymarkers – signif. ↓CRP < 25 % from the
baseline within 24hrs.
- Contagiousness of patient
– BC 24 hrs. BS5days

27. 9. Initial therapy may need modification after culture
results areavailable
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

28. Dangers of Indiscriminate Use
- Widespread sensitization of population
- Changes of normal floraof body --> overgrowth of
resistant organisms
- Masking serious infection without eradicating it (e.g.
abscess)
- Direct Drug Toxicity
- Development of drug resistance
- Alteration of individual and hospital bacterial ecology
- Possibility of antagonism (ie. penicillin and tetracyclin)
- Higher cost oftreatment
- False sense ofsecurity

29. Toxicity of commonly use Antibiotics
Drugs Common occasional
Penicillin Allergic reaction/diarrhoa Anaphylaxis
Cephalosporins Thrombophlebitis/ GI
symp
Aminoglycosides Nephro/ototoxicity
Erythromycin GI irritation/ stomatitis
Clindamycin Diarrhoea/ rash
levofloxacin headache, dizzinessor
lightheadedness.
Nephrotoxicity,
phototoxiciy

30. Conclusion
Significant current achievements in medicine are
attributed to good use of antibiotics
Sound knowledge and application of principle of
antibiotic use will prevent dangers associated with
indiscriminate use ofantibiotics

31. Thank u for listening