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Cephalosporins in surgery. Prophylaxis and therapy
1Department of Community Health, Tufts University School of Medicine, Boston.
Drugs
|January 1, 1987
Summary
Surgical prophylactic antibiotics, especially cephalosporins, reduce complications and hospital stays. Effective antibiotic selection depends on the surgical site and potential pathogens, including Gram-positive organisms and anaerobes like B. fragilis.
Area of Science:
- Surgical Infectious Disease
- Pharmacology
- Clinical Microbiology
Background:
- Prophylactic antibiotics in surgery aim to prevent complications, reduce mortality, and shorten hospital stays.
- Antibiotic prophylaxis relies on achieving effective tissue concentrations at contamination risk or reducing bacterial inoculum, particularly in colorectal surgery.
Purpose of the Study:
- To review the indications and effectiveness of prophylactic antibiotics in various surgical procedures.
- To guide the selection of appropriate antibiotics based on surgical site, potential pathogens, and proven clinical activity.
Main Methods:
- Literature review of studies evaluating prophylactic antibiotic use in surgery.
- Analysis of antibiotic spectrum requirements for different surgical specialties (e.g., orthopaedic, cardiac, colorectal).
Main Results:
- Cephalosporins are widely used and effective in reducing postoperative morbidity across numerous procedures.
- Antibiotic selection should target Gram-positive organisms for orthopaedic, cardiac, and gynaecological surgery; include oral anaerobes and Enterobacteriaceae for head and neck surgery; and target B. fragilis for colorectal surgery.
Conclusions:
- Appropriate selection of prophylactic antibiotics, considering the specific surgical context and microbial targets, is crucial for preventing surgical site infections.
- Prompt surgical intervention remains primary for intra-abdominal sepsis, with antibiotic therapy adjusted based on culture results.