ROLE OF ANTIBIOTICS IN SURGERY

1. TOPIC : ROLE OF ANTIBIOTICS IN SURGERY

2. Outline
INTRODUCTION
GENERAL PRINCIPLES OF ANTIBIOTICS USE
MECHANISM OF ACTION
ANTIBIOTIC PROPHYLAXIS
THERAPEUTIC ANTIBIOTIC

3. Introduction
Definition
 Antibiotics; Are products of various species of micro-
organisms including bacteria, fungi and actinomycetes
that suppress growth or kill other micro-organisms
 Antimicrobial (antibacterial) is a term use to including
purely synthetic agents such as:
 Sulphonamides
 Quinolones

4.  Historical Background
- Louis Pasteur and Robert Koch1877
- In 1928, AlexanderFleming
- Selman Waksman, in 1942
- 1960’s MILES AND BURKE

5. Classification of antibiotics

6. Group/mechanism of Action
1- Cell wall synthesisinhibitors
(inh. Peptidoglycan synthesis)
B-lactem- Penicillins/cephalosporins
others- vancomycin/ bacitracin
2- Protein synthesis inhibitors
(interfere with 50s or 30s of rRNA)
Tetracyclines , Aminoglycoside ,
Macrolytes,chloramphenicol
clindamycin
3- Folate Antagonists (Sulphonamides)
Inhibitor folate synthesis or reduction
eg sulfamethoxazole, Trimethoprim
4- Quinolones
DNA gyrase inhibitors
eg ciprofloxacin, levofloxacin
5- Nitroimidazole Eg metronidazole
6-RNA polymerase inhibitor eg Rifampicin

7. Mode of action
bacteriostatic
 Chloramphenicol
 tetracyclines
 macrolides
 Sulphonamide
 clindamycin
bactericidal
 penicillins,
 Aminoglycoside
 Cephalosporin
 Metronidazole
 quinolones

8. Base on Spectrum of activity
- Narrowspectrum
- Extended spectrum
- Broad spectrum

10. JUSTIFICATION :
 Treatmentand prevention of infection is a cardinal
responsibility of the surgicalteam.
 Favorableoutcomeof surgeries wererecorded with
appropriate use ofantibiotics
 SSI increase mortality, morbidity, hospital stayand
cost of treatment

11. Selection of antibiotics
 Requires knowledgeof
- The organism's identityand its sensitivity toa
particularagent
- The site of the infection (CNS, bone, GI, UT)

12. is the use of antibiotic to prevent anticipated infection.

13. Indications for prophylaxis in
surgery
 Wounds
- Clean contaminated and contaminated wound
- Clean wound in which implantsorprosthesis are inserted
- Animal or Humanbite
- Open fracture
- Delay to cleaning > 6hrs
- Foot/ Hand wounds
- Wound length > 5cm
- Crush
- Wound involving body cavity/ perineum
- Immuno-suppressed patient
- Burns

14. General considerations
 Nota substituteoralternative toaseptic practiceand
good surgical technique.
 Necessary only in high-risk casesof bacterial
contamination
 Preop selection of antibiotic should consider the
normal flora in clean casesand the likelycontaminant
in dirtycases
 Adoptionof Policy on typeantibiotics touse is
infortant

15. Anatomical site Normal flora
Skin Staphylococcus, streptococcus
propionibacteria
Oral cavity Above, anaerobes & gram negative
rods
Nasopharynx Staph., strept., H. influenzae and
anaerobes
Thorax Staph, strept, and propionibacteria
Oesophagus - jejunum Flora of nasopharynx +
enterobacteriaecea
Large bowel Gram –ve rods, enterococci &
anaerobes
Female genital tract Flora of large bowel, staph strept, &
H. influenzae
Urinary tract Normally sterile
Limbs Staph, strept, propionibacteria

16. Therapeutic antibiotics is given to fight infection that
is alreadyestablished.

17. 1. Establish a Clinical Diagnosis and the need for
Antibiotics base on history and physical examination

18. 2 - Determine the Urgency of thesituation
 Non-urgent situation: mild infection orchronic
infection
 Urgent situation:- Suspected severeinfection

19. 1. Obtain an appropriate clinical specimens for
examination, culture andsensitivity
2. Remove barrier to cureby
- Debridement
- Good woundcare

20. 5. Determine the most likelyorganism causing the
infection
 Focus of infection
 Age
 Epidemiologic features
 Prior culturedata

21. 6. If multipleantibioticsareavailable to treat pathogen,
choose the bestagent
 Prior antibioticallergies
 Antibioticpenetration
 Potential sideeffects
 Medical condition of thepatient

22. 7- Antibiotic combination can be considered to achieve
Synergism

23. 8. Initial therapy may need modification afterculture
results areavailable
 Modification not necessary if there issignificant
Relief of symptoms
 Narrowspectrum of antibiotics should be used (to
decrease the risk ofcolonization)
 Negativecultures

24. Conclusion
 Significant current achievements in medicineare
attributed to good use ofantibiotics
 Sound knowledge and application of principle of
antibiotic usewill preventdangers associated with
indiscriminate use ofantibiotics

25. Thank you