Survey of guidelines for antimicrobial prophylaxis in surgery

One method of making optimal use of prophylactic antibiotics is for interested parties to agree on guidelines. A postal survey was undertaken to determine the prevalence of this practice within UK hospitals and details of any guidelines used. Eighty-one of the 160 respondents (51%) stated that guidelines were available or in preparation. Prophylaxis was recommended by 100% of respondents for colorectal surgery and prosthetic joint replacement and by 96% for gastro-oesophageal surgery, procedures where it has been proven to be of benefit. Prophylaxis was recommended for the following procedures for which its efficacy remains controversial: cholecystectomy (100%); peripheral vascular grafting (93%); hysterectomy (95%) and noncardiac thoracic surgery (63%). Although 35 combinations of 22 different antimicrobials were recommended, 63% included a cephalosporin; the greatest variety of antibiotics recommended was for peripheral vascular grafting. In 88% of policies it was advocated that prophylaxis be started preoperatively and in 79% that it be continued for less than 24 h. When surgery involved the implantation of a prosthesis the duration of prophylaxis tended to be prolonged. Policies for the prescribing of antimicrobial prophylaxis in surgery are available in many hospitals and for the most part conform with established principles.