Prophylactic antibiotic regimen in surgery

This is an automatically translated article.

This article is professionally consulted by resident Doctor Le Thanh Tuan - Gastroenterologist - General Surgery Department - Vinmec Nha Trang International General Hospital.
Prophylactic antibiotics in surgery are often indicated for use in certain types of surgery in order to minimize surgical site infection. Prophylactic antibiotic regimens are made based on many different bases such as patient condition, type of antibiotic.

1. What is prophylactic antibiotics?

Prophylactic antibiotics are antibiotics used before surgery in order to minimize infection at the surgical site. Prophylactic antibiotics are indicated in cases of high risk of infection depending on the type of surgery as well as the specific condition of the patient.
Prophylactic antibiotic regimens are formulated before surgery, based on the following characteristics:
Bacteria: Potentially infectious agents, sensitivity of bacteria to antibiotics, risk resistant bacteria, prevalence of C. difficile infections in hospitals. Antibiotics: Spectrum of drug action, sensitivity of bacteria to antibiotics, pharmacokinetics (organic permeability, half-life) and cost of the drug. Patient: History of antibiotic allergy, kidney function in case of using multiple antibiotics. However, a prophylactic antibiotic regimen, no matter how effective, is still not a substitute for good surgical technique as well as thoughtful postoperative care.

2. The principles of antibiotic prophylaxis you should know

2.1 Classification of surgery using prophylactic antibiotics Surgery is classified into four categories including clean surgery, clean-contaminated surgery, infected surgery and dirty surgery.
If clean surgery is a surgery where the incision does not go through the infected area, does not involve the respiratory tract, digestive system, urinary tract and genitals, then clean surgery is the type of surgery where the incision goes through the above pathways under control and without unusual inflammation. These two types of surgery will be prescribed to use prophylactic antibiotics after surgery.
Infectious surgery is a type of surgery where the incision goes through the area of ​​​​inflammation, massage the heart after opening the thorax or surgery to treat perforation of the digestive tract. Dirty surgery is a type of surgery where the incision goes through the wound with necrotic tissue, infection due to perforation of hollow viscera, post-operative infection... Moreover, they have a therapeutic role.
2.2 Criteria for choosing antibiotics in surgery The selection of prophylactic antibiotics has many different criteria, the main criteria include:
Antibiotics are effective against the main strains of bacteria that cause infection at the surgical site. Antibiotics with the least toxic effects Antibiotics must not interact with anesthetics Use antibiotics at a reasonable cost 2.3 Ways to use antibiotics in surgery There are four avenues for antibiotic prophylaxis in surgery:
Intravenous infusion: This method is often prescribed by doctors because it works quickly, helping to bring drug levels in the blood and tissue to the fastest standards.

Intramuscular injection: Although it can be used, the absorption time is slower and the stability is not high. Oral: Use only in case of rectal or colon surgery. Direct use: Depending on the type of surgery, the doctor will have appropriate indications, for example, in joint replacement surgery, antibiotics will be impregnated in the cement. 2.4 Time to use antibiotics in surgery Prophylactic antibiotics should be used within 1 hour before surgery, calculate the time so that the concentration of antibiotics in serum and tissue reaches the highest bactericidal level right before incision skin.
Add more prophylactic antibiotics if the surgery lasts more than three hours and the patient loses a lot of blood during the procedure.
The following is the time and dosage of some prophylactic antibiotics:

3. Prophylactic antibiotic regimens in some specific surgeries:

Urological surgery and procedures Heart surgery Vascular surgery Thoracic surgery Neurosurgery Orthopaedic Surgery Obstetric surgery Currently, with the goal of safe surgical patients and rational use of antibiotics, Vinmec International General Hospital continues to implement measures to increase the quality of prophylactic antibiotic use. Prophylactic antibiotic regimens in surgery based on international standard studies are administered by clinical pharmacists. The appointment is always made by a team of qualified doctors with modern medical equipment to bring the best treatment results to patients.

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