Use of prophylactic antibiotics in surgical practice

During the last decade great inroads have been made concerning the appropriate use of antibiotic prophylaxis in the surgical patient. Well-controlled, prospective, blinded studies have outlined many of the areas in which antibiotic prophylaxis is of benefit, as well as those clinical situations in which the risks of antibiotic prophylaxis outweighed the expected value. Historically, the most common errors in usage include the widespread use of antibiotic prophylaxis in clean surgery and the faulty timing of administration. The most common error today (in the use of prophylactic antibiotics in surgical practice) is continuation of the agents beyond the time necessary for maximal benefit. In order to appropriately administer prophylactic antibiotics in the various clinical settings on the surgical service, in which this practice has been of proved value, one must be aware of the following nuances including (1) choice of the antibiotic agent based on the type of organisms usually causing infection, (2) route of its administration, (3) the dosage necessary to attain efficacious tissue or serum levels, and (4) the timing of administration which offers the maximum benefits without risking the adverse effects.