[Guidelines for perioperative antibiotic use in digestive tract surgery]

Guidelines for the use of antibiotics in postoperative infections after digestive tract surgery have been under discussion in Japan since the mid-1980s, when the number of infections with methicillin-resistant Staphylococcus aureus began to increase. It is important to make a distinction between prophylactic and therapeutic antibacterial administration in the perioperative period. Prophylactic antibacterial administration to prevent postoperative infection is necessary to prevent surgical site infection and remote infection from invading the surgical site. Because the type of bacterial contamination of the surgical site differs with the organ undergoing surgery, the type of antibiotic selected also differs. Antibiotic administration to prevent postoperative infection after surgery requiring a short time to perform may be started preoperatively. In patients undergoing prolonged surgery, antibiotics are administered every 3 hours. If an antibacterial agent is administered for 3-4 days, there is a risk of the development of resistance and therefore administration should not exceed 3-4 days, including the day of surgery. However, during surgery in which bacterial contamination is already evident, the therapeutic use of antibiotics should be initiated at diagnosis. For example, toxinemia is common in many cases of colon rupture and the administration of powerful antibiotics is necessary to save patients' lives.