Antibiotic prophylaxis and treatment of surgical abdominal sepsis

The incidence of surgical abdominal sepsis is related to the operation, patient and skill of the surgeon, ranging from <2-3% for laparoscopic cholecystectomy to >35-40% in overt peritonitis. Aged, obese, diabetic, neoplastic, acute patients have the highest incidence of sepsis. Antibiotic prophylaxis significantly reduces the incidence of postoperative infections for Class II and II operations. The proper timing (30-60 min before incision), choice of antibiotic (related to possible pathogens) and correct duration are essential. Ultra-short prophylaxis (only one administration) may be effective in most class II procedures and a cephalosporin can be used. Class II operations (colorectal) may require a booster dose soon after surgery or during surgery exceeding 3 h. The most effective regimen may include: ampicillin, clindamycin, I- II- III- or IV-generation cephalosporins, amoxycillin, aminoglycosides, metronidazole have been used alone and in combination. Combination prophylaxis should be active against aerobic and anaerobic bacteria. Treatment of surgical abdominal sepsis may be primary, seconday or tertiary. Surgery should remove the pathologic lesion, and antibiotics reduce the general effects of sepsis and infectious complications. This article presents information on the general rules for correct prophylaxis and treatment.