Academic presentation as junior resident in orthopaedic and trauma at National Orthopaedic Hospital Dala Kano. by Dr Kabiru SALISU kbmed2003@yahoo.com

1. by
Dr Kabiru Salisu
NOHD

2. Outline
INTRODUCTION
GENERAL PRINCIPLES 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 MILES AND 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 bactericidal
 Chloramphenicol
 tetracyclines
 macrolides
 Sulphonamide
 clindamycin
 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 the surgical team.
 Favorable outcome of surgeries were recorded with
appropriate use of 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 dirty cases
 Adoption of Policy on type antibiotics to use is
infortant

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 culture data

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 the patient

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

26. 8. Assess effectiveness of antibiotic therapy
- Clinical assessment –
↓ temperature - 48 hrs 4BC antibiotics
3 - 4days 4BS drugs
- Inflammatory markers – signif. ↓CRP < 25 % from the
baseline within 24 hrs.
- Contagiousness of patient –
BC 24 hrs.
BS 5 days

27. 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

28. Dangers of Indiscriminate Use
- Widespread sensitization of populace
- Changes of normal flora of 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 of treatment
- False sense of security

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 Diarrhoa/ rash
levofloxacin headache, dizziness or
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 of antibiotics

31.  Richard A.H , Pamela C.C: Illustrated Reviews of pharmacology, 2nd Edition.
lippincott’s 2002
 Bertram G. katzung: basic and clinical pharmacology, 9th Edition. Lange
Medical Books 2002.
 Al-fallouji M. A: post graduate surgery, 2nd edition, Read publishing Ltd. 1998
 Vanderpuye V. in principle and practice of medicine of surgery including
pathology in the tropics, 4th edition 2010.
 Salmon S. E & Sartolli A. C, Cancer chemotherapy in Basic and Clinical
Pharmacology, Lange 1998. P881-911
 Hospital infection control policy, NHS Trust Decument No- HIC 18
 Titigah B. A, Antibiotic in surgery, www.authorstream.com 2010
 Antibacterial, www.wilkipedia.com 2010
 Fahimtola F. A, Antibiotics internal medicine primary exams revision course,
NPMCN 2008
 Michal halub; basic principles of antibiotic use, UH boluvka.
References

32. Thank u for listening