ANTISEPSIS

Samriti Sharma
Group 318 ‘C’
• Antisepsis is the process of destruction of disease causing microorganisms
to prevent infection in patient’s body.
• The process may be either bactericidal or bacteriostatic.
 Types of antisepsis
• Mechanical
• Physical
• Chemical
• Biological
 Mechanical antisepsis
• based on surgical debridement of wounds.
• This is performed in the surgical theatre and involves excision of the
edges, walls and the floor of wounds to remove the non-viable tissue and
microorganisms within the wound.
• It is the major method to treat accidental, infected wounds
 Physical antisepsis
It starts from the law of
• capillarity
• hygroscopicity
• diffusion
• osmosis
• siphoning
• ultrasound
• laser effects
Principles used are:
• to enhance drainage from wounds and pus from abscesses and empyemas
• to facilitate flow to the outside (into a dressing or a special container with
antiseptic solution).
 Chemical antisepsis
• Synthetic antibacterial agents are used to combat bacterial infection in the wound.
• Derivatives of nitrofuran
Furacilin
Furagin
• Acid group
• Oxidants
Hydrogen peroxide
Potassium permanganate
• Detergents
Chlorhexidine
Dioxidin
 Topical chemotherapy
• Application of antiseptics to dressing materials for wounds and burns; these
may be applied in the form of solutions used to wash wounds during dressing,
soaking the dressing packs as well as in the form of creams and powders.
• application of antibacterial solutions directly into the wound, closure of the
cavity with subsequent aspiration through a drain — washing, leaking
drainage.
• infiltration of foci of inflammation with antibacterial solutions to combat local
infection.
 Systemic chemotherapy
• oral use of antibacterial agents: tablets of Furagin, Solafur, long-acting
and very long- acting sulfonamides (sulfadimethoxin, sulfalcn) which act
topically on gastrointestinal microorganisms; this is part of preoperative
workup for patients with impending intestinal surgery. Absorbed into the
blood stream, these drugs also act on the body systemically after they
have been absorbed into the bloodstream.
• intravenous use of chemotherapeutic compounds: e.g. soluble furagin,
dioxidin
 Biological antisepsis
• Biologic antisepsis is the natural method of combating sepsis.
• its underlying principle is prophylaxis—the prevention of the
development of putrefactive and pathogenic organisms by the
maintenance of a vigorous growth of aciduric organisms.
The major antibiotics used for treatment and prophylaxis of infections are as
follows:
• The penicillins
1. Drug inactivation (by producing β-lactamase
enzyme): Seen in both gram-positive and
gramnegative bacteria
2. Alteration of target sitePBP (penicillin-
binding protein) is altered to PBP2a, seen in
gram-positive bacteria
3. Decreased permeability as in gram-negative
bacteria- due to altered outer-membrane porins
• Cephalosporins
First- and second-generation cephalosporins
include ceporin (cephaloridin), kefzol
(cefazolin), cephalothin, and cephalexin;
cephataxime, cefotaxim, ceftriaxon are
third-generation cephalosporins, and
cefpirom (Quiten) belongs to fourth-
generation cephalosporins.
ESBL (extended spectrum β-lactamases
• Aminoglycosides
These include gentamicin, kanamycin,
tobramycin and semisynthetic aminoglycoside
(amikacin)
1. Drug inactivation by aminoglycoside-
modifying enzyme
2. Decreased permeability through gram-
negative outer membrane
3. Decreased influx of drug
• Tetracyclines
These include tetracycline,
oxytetracycline and semisynthetic
tetracyclines (metacycline or
rondomycin), doxycycline (vibramycin).
1. Decreased intracellular drug
accumulation (active efflux)
2. Ribosomal target site alteration
• Macrolides
These include erythromycin,
oleandomycin, azithromycin.
1. Alteration of ribosomal target
2. Active efflux of antibiotic
• Fluorquinolones
Norfloxacin, ciprofloxacin,
ofloxacin
1. Alteration of target (mutation of
DNA gyrase genes)
2. Poor transport across cell
membrane
 Characteristics of antibiotic therapy
• Indications : Antibiotics should not be prescribed unless they are indicated. Antibiotics are meant to
supplement treatment rather than replace surgical management.
• Contraindications : Allergic reactions, the presence of renal, hepatic diseases, hearing defects or
pregnancy.
• The choice of antibiotics : Antibiotics are chosen individually according to the causative infectious agent.
In purulent surgical diseases caused by mixed infections, a combination of semi-synthetic penicillins and
aminoglycosides is highly effective.
Chloramphenicol is indicated for infections caused by non-sporiferous anaerobic strains.
In Proteus-caused infections, a combination of carbenicillin and aminoglycosides may be effective.
Aminoglycosides and polymixin act, for example, at the stage of proliferation, while at other stages of
microbial life cycle these may appear ineffective.
 Dosing

• Antibacterial (bactericidal or bacteriostatic) effect of the agents only

occurs if particular concentrations at the focus of infection or in blood for
a particular period are being maintained.
• The minimum inhibitory concentration is the least amount of drug
necessary to inhibit visible growth after 24 hours.
• If the concentrations of the drug are too high, in addition to its
antibacterial effect it can cause a number of adverse effects.
 Immune compounds
• For active immunization anatoxins are used.
Staphylococcal anatoxins ,Tetanus antitoxin
• For passive immunization preparations containing antibodies to causative agents of other
surgical infections are used.
Antistaphylococcal hyperimmune plasma
Antistaphylococcal gamma globulin
Antitetanus serum
• Immune stimulators are the agents that improve non-specific immune defense of the body
include prodigiozan, lyzozyme and levamisole.
Thank you!