Guidelines for antibiotic

use

By Doctor Saleem
Holy Family Hospital Rawalpindi
 Surgical wound classification
according to contamination
Clean:
Uninfected operative wound in which no
inflammation is encountered and the
respiratory, alimentary, genital, or infected
urinary tract are not entered. Wounds are
primarily closed and, if necessary, drained
with closed drainage.
Infection rate 3.3%
 Clean contaminated
Operative wound in which the respiratory,
alimentary, genital or urinary tracts are entered
under controlled conditions and without
unusual contamination
Infection rate 10.8%
 Contaminated
Open, fresh, accidental wounds. In addition,
operations with major breaks in sterile
technique or gross spillage from the
gastrointestinal tract, and incisions in which
acute, nonpurulent inflammation is
encountered are included in this category
Infection rate 16.3%
 Dirty
Old traumatic wounds with retained devitalized
tissue and those that involve existing clinical
infection or perforated viscera. This definition
suggests that the organisms causing
postoperative infection were present in the
operative field before the operation.
Infection rate 28.6%
 Antibiotic Prophylaxis Guidelines
A single preoperative dose of antibiotic is as
effective as full five days course of therapy
assuming uncomplicated procedure.
Prophylactic antibiotics should be
administered within 1 hour prior to incision,
preferably with induction of anesthesia.
Prophylatic antibiotics should target
anticipated organisms.
 Contd;
Prophylaxis should not be extended beyond 24 hours
following surgery.
One preoperative and two or three postoperative doses
are sufficient in clean surgery.
Contaminated and dirty procedures should additionally
receive additional postoperative coverage.
During prolonged procedures antibiotic prophylaxis
should be readministered every 3 hours.
Use of antibiotic in procedures classified as
contaminated or infected should be used as therapeutic
and not prophylactic.
 Contd;
In traumatically injured patients antibiotics cannot be
given before bacterial contamination occurs.
Cephalosporins especially cephazolin is 1st line
prophylactic agent for most surgical procedures
because of their low toxicity, long serum half life,
broad spectrum of activity, low cost. Third generation
should not be used for routine prophylaxis because
they promote the emergence of resistance.
 Available antibiotics
(In Wards)
Inj Augmentin
Inj Ampiclox
Inj Flagyl
Inj Ceftriaxone
Tab novidat
Inj Cephradin
 (In Emergency)
Inj ceftriaxone
Inj cefotaxime
Inj Benzyl penicillin
Inj novidat
Inj Flagyl
Inj gentacin
Inj cephradine
Procedure Likely Recommen Available Alternative
Organisms ded drug
CARDIO- STAPH CEFAZOL CEPHRA CLINDA
THORACI AUREUS, IN, DINE MYCIN,
C STAPH,EP CEFAMA VANCOM
STREPT, NDOLE,C YCIN
GRAM EFUROXI
VE ME
BACCILI
Vascular Staph, Cefazolin, Cephradine Clindmyci
Surgery Enterococc Cefuroxim n
us,gram-ve e
baccili
Head and Organism Clindamy Available Altrnate
Neck Are cin is Include Cephazoli
Surgery Anerobes, recomend metrnidaz n+Metron
ed idazole
Staph ole +
Aureus, Cephradi
Gram-ve ne

Urology Gram-ve Cefazolin Ciproflox Ciproflox

surgery bacilli acin acin,
(high risk Enterococ Gentamyc
Only) us in
Diabetic,
Catheteriz
ed
Orthopedi Common 1st line Available 2nd line
c surgery Organims
1)Closed Staph
fracture aureus, Cefazolin Cephradi Clindamy
Staph epi ne cin

2) Open Staph, Cefazolin Cephradi Clindamy

fracture Strept, +Gentcin n+Gentac cin+
Gram-ve in Gentacin
Baccili,
Anearobe
s
Amputati Clostridia Metronid Augmenti
ons Gram ve azole+ n+
Bacili, Gentacin Gentacin
Gram+ve +Flucoxa +Metroni
Other cilin dazole
anerobes

General Organism 1st line Available 2nd line

Surgery Enteric Cephazoli Cephradi Clindamy
Gastoduo Gram-ve n n, cin+
denal,Eso Bacilli, Augmenti Gentacin
phagial Gram +ve n+Gentac
(High risk cocci in
only)
Biliary Enteric Cefotaxi Cefotaxi
Tract Gram-ve me single me
dose,
Surgery Bacilli,
Cefazolin

Appendic Enteric Cefazolin Cephradi Cefoxitin

ectomy Gram-ve +Metroni n+Metron
dazole idazole
bacilli
03doses
in non
perforated
,5days in
perforated
Colon Enteric Oral Oral
Surgery Gram-ve Prophyla neomycin
xis +metroni
(Elective) Bacilli,
Oral dazole
Enterococ
cus, neomycin I/v
+erothroc Ampicilin
Anaerobe in base 1g I/v
s +Gentaci
Each Cefotaxi n+Metron
at1300,14 me+ idazole
00,2100hr metronida
s preop zole One
I/V dose or
Cefazolin gentacin+
+metroni metronida
dazole zole
Non Cefoxitin
elective 1g preop+
3 postop
doses 8
hrly

Laprosco No
pic antibiotic
Cholecyst prophlaxi
ectomy s required
Herial No
repair prophylax
without is
mesh required

Repair Cefazolin Cephradi

with Single n
mesh dose
Strangulat Anerobic Cefoxitin Cefotaxi
ed Hernia and 1g 8hrly me+metro
Gram-ve nidazole
Bacilli
Penetratin Enteric Cefazolin Metronid Metronid
g Gram-ve +metroni azole+Cef azole+gen
abdominal bacilli dazole otaxime tacin
trauma Enteroco
ccus,
Anaerob
es

Breast Augmenti
Surgery n
Acute Gram ve Ciproflox
Cholecyst Bacilli+A acin
itus nerobes 500mg
BD+Metr
onidazole
400mg
TDS

Acute Cefuroxi Cefotaxi

Pancreatit me me
us(low
risk)
High Risk Imipenum
 Antibiotics in pregnancy
Penicillin , Cephalosporin's and Erythromycin
are the drug of choice.
Quinolones, Tetracycline ,Streptomycin are
contraindicated
Amino glycosides , Metronidazole (except 1 st
trimester) , Sulphonamides Can be taken when
indicated.


Thank You