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Perioperative Antibiotics

Perioperative Antibiotics . Why, When, and Which Ones?. Ryan Rahman Tulane SOM 2012 Anesthesia Rotation 11/18/2011. Why?. Surgical site infections continue to be a significant cause of mortality and morbidity post-operatively.

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Perioperative Antibiotics

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  1. Perioperative Antibiotics Why, When, and Which Ones? Ryan Rahman Tulane SOM 2012 Anesthesia Rotation 11/18/2011

  2. Why? • Surgical site infections continue to be a significant cause of mortality and morbidity post-operatively. • Perioperative antibiotic prophylaxis along with other operative measures can greatly reduce this risk • Anesthesiologist should be mindful of drug selection, timing of administration and redosing during the procedure if needed • The focus should be on treatment of appropriate suspected flora. Contaminated or dirty procedures may require additional coverage

  3. Which Ones?

  4. Dose & Timing • Dosing is based on weight. However many institutions elect to administer a standard dose of cefazolin or cefotetan to all adult patients as the toxicity of these drugs are low • Most antibiotic prophylaxis should be administered via IV within 60 mins of incision. In cases where vancomycin and fluoroquinolones are used, they must can be given up to 120 mins before incision due to slow infusion times. • Studies have shown that continuation of antibiotic prophylaxis after the procedure has no change in outcomes. AMP should be discontinued w/in 24 hrs. • Cardiothoracic surgery may require continuation of AMP for up to 48 hours.

  5. Special Considerations • Beta-lactamallgery • - True allergy? Alternatives are available • MRSA & VRE • - consider vancomycin or linezolid • Infective endocarditis • - No additional AMP needed • Procedures lasting 4 hrs or greater • - Redose according to drug’s half life

  6. Conclusion • AMP can significantly reduce the number of surgical site infections • Anesthesiologists should take charge of administering appropriate antibiotics • Treatment should be based on specific cases and the prevalence of local bacteria and resistance patterns • Further research is needed in the cases of MRSA colonization and penicillin skin testing

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