Surgical antibiotic irrigations

Instillation of antibiotic solutions into surgical wound sites seems empirically attractive since relatively high concentrations of antibacterial agents can be applied directly to the probable site of infection. However, systemic effects provided by antibiotic assimilated from sites of application are responsible for much of the activity and toxicity of antibiotic irrigations. The most appropriate drugs and dosages for use as prophylactic antibiotic irrigations have not been determined. Most controlled trials conducted in recent years have utilized various cephalosporins in concentrations of 1 to 4 g/L. In some of these trials, surgical irrigation has been found as effective as prophylactic intravenous antibiotics, which are the proven and accepted standard. Reported cases of toxicity associated with antibiotic irrigations are few in number, excepting neomycin, which has caused postoperative respiratory depression/apnea, permanent deafness, and renal failure.