Antibiotics in ENT Surgery. Magdy M. Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of Dundee. Prophylactic antibiotics.
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Magdy M. Amin RIAD
Professor of Otolaryngology.
Ain shames University
Senior Lecturer in Otolaryngology
University of Dundee
Choosing an antibiotic for prophylaxis is multi-factorial and should be based on the following:
in which no inflammation is encountered .
The respiratory, alimentary or genitourinary tracts are not entered.
There is no break in aseptic operating theatre technique.
in which the respiratory, alimentary or genitourinary tracts are entered
but without significant spillage.
where acute inflammation (without pus) is encountered.
or where there is visible contamination of the wound.
Examples include gross spillage from a hollow viscus during the operation
or compound/open injuries operated on within four hours.
In the presence of pus.
where there is a previously perforated hollow viscus,
or compound/open injuries more than four hours old.
0 1 2
Clean 1.0% 2.3% 5.4%
Clean-contam. 2.1% 4.0% 9.5%
Contaminated 3.4% 6.8% 13.2%
Prophylaxis should be started preoperatively in most circumstances
ideally within 30 minutes of the induction of anesthesia.
Antibiotic prophylaxis should be administered immediately before or during a procedure.
Prophylactic antibiotics should be administered intravenously.
The single dose of antibiotic for prophylactic use is, in most circumstances, the same as would be used therapeutically.
An additional dose of prophylactic agent is not indicated in adults, unless there is blood loss of up to 1500 ml during surgery or haemodilution of up to 15 ml/kg.
Fluid replacement bags should not be primed with prophylactic antibiotics because of the potential risk of contamination and calculation errors.
1. Prophylactic perioperative antibiotics should be started prior to skin incision for maximal benefit.
2. There is no advantage to continuation of perioperative antibiotics beyond 24 to 48 hours postoperatively has ever been demonstrated.
The possible exception to this is metronidazole;
The antibiotic may alternatively be given for a full 48 hours postoperatively.
there is no compelling evidence that the additional 24 hours confers any additional benefit.
2. Augmentine: 1.5 grams IV within 1 hour of surgery .
and 8 additional doses at 6-hour intervals following surgery.
3. Cefazolin: 2.0 grams IV within 1 hour of surgery.
and 3 postoperative doses at 8-hour intervals.
This regimen may be extended to a total of 48 hours postoperatively.
4. Cefazolin/metronidazole: cefazolin 1 gm IV 1 hour prior to surgery
then 1 gram IV every 8 hours postoperatively for a total of 6 doses.
and metronidazole 900 mg IV 1 hour prior to surgery
then 900 mg IV every 8 hours postoperatively for a total of 6 doses.