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[The role of new molecules in surgical antibiotic prophylaxis]
Abstract:
The preoperative administration of a new antibiotic for antimicrobial prophylaxis is questionable because of the methodological difficulties to demonstrate its efficiency and benefits in decreasing the postoperative infectious complications. As their rate is very low, especially in clean surgery, the number of patients to be included in a comparative trial is very high. Most studies assessed only small groups and therefore any extrapolation for clinical practice is of limited value. Because of their therapeutic efficiency the fluoroquinolones are often recommended for antimicrobial prophylaxis. However, the rapid occurrence of resistances, directly related to their prescription should invite the prescribers to be cautions. They should be contra-indicated as long as an alternative of similar efficiency is existing, in case of bacteraemia, when an administration of more than 48 hours in required or when the intra-hospital resistance rate exceeds 10 p. 100.
Insights
Evaluating new antibiotics for antimicrobial prophylaxis is challenging due to low complication rates and large trial requirements. Fluoroquinolones are effective but raise concerns about resistance, necessitating cautious use in prophylaxis.
Area of Science:
- Infectious Diseases
- Clinical Pharmacology
- Surgical Infections
Background:
- Antimicrobial prophylaxis is crucial in surgery to prevent postoperative infectious complications.
- Assessing new antibiotics for prophylaxis faces methodological hurdles, including the need for large patient cohorts due to low event rates, especially in clean surgery.
- Existing studies often involve small sample sizes, limiting the generalizability of findings to clinical practice.
Purpose of the Study:
- To evaluate the challenges in demonstrating the efficacy and benefits of new antibiotics for preoperative antimicrobial prophylaxis.
- To discuss the appropriate use of fluoroquinolones in antimicrobial prophylaxis, considering the risk of resistance development.
Main Methods:
- Review of existing literature on antimicrobial prophylaxis and clinical trials.
- Analysis of factors influencing the design and interpretation of studies on surgical site infections.
- Examination of fluoroquinolone resistance patterns and their implications for clinical guidelines.
Main Results:
- Demonstrating the efficacy of new prophylactic antibiotics is difficult due to the low incidence of postoperative infections, requiring extensive clinical trials.
- Fluoroquinolones, while effective, are associated with rapid resistance development.
- High intra-hospital resistance rates (>10%) and specific clinical scenarios (bacteraemia, prolonged use >48 hours) warrant contraindication of fluoroquinolones if alternatives exist.
Conclusions:
- Methodological challenges complicate the evaluation of new antibiotics for antimicrobial prophylaxis.
- Judicious use of fluoroquinolones is essential to mitigate the emergence of antimicrobial resistance.
- Prescribers should exercise caution with fluoroquinolones, reserving them for situations where alternatives are less suitable and monitoring resistance rates.