Prophylaxis for intraabdominal surgery

Great progress has been made in the last decade concerning the appropriate use of antibiotic prophylaxis in the patient undergoing abdominal surgery. Well-controlled, prospective, blind studies have outlined many of the areas in which antibiotic prophylaxis is of benefit as well as those clinical settings in which the risks of antibiotic prophylaxis outweigh the expected value. Historically, the most common errors in usage included the widespread use of antibiotic prophylaxis in clean surgical procedures as well as the faulty timing of initial administration. Currently, the most common error is the practice of continuing the administration of the antibiotic agents beyond the time necessary for maximal benefit (greater than 72 hr). In order to administer prophylactic antibiotics appropriately in the various clinical settings on the surgical service in which this practice has been of proven value, one must be aware of the following nuances: (1) the choice of the antibiotic agent should be based on the type of organisms usually causing infection; (2) the route of administration must be appropriate; (3) the dosage necessary to attain efficacious levels of antibiotic in tissue or serum must be appropriate; and (4) the timing of administration should offer the maximal benefits without risk of the adverse effects.