Use of prophylactic antibiotics in surgery

A prospective survey of 352 surgical patients revealed that 52% (183 patients) were given antibiotic drugs perioperatively, (32% (111 patients) for prophylaxis and 20% (72 patients) for treatment of established infection). Prophylaxis was not reasonably indicated in only 24 patients, but there was little standardization of drug, dose, timing or duration of courses. The mean duration of prophylactic courses was six days; less than half began before operation. Thirty-two patients (11% of 283) developed an infection after operation; the incidence in patients with and without antibiotic prophylaxis was 17% (19/111) and 8% (13/172) respectively, but the former were, in general, higher risk subjects. Antibiotic use determines the emergence of resistant microorganisms and efficacy of prophylaxis is in the main unproven. Clearly, a carefully considered policy on antibiotic prophylaxis within an institution is a logical necessity yet to be realized.