Perioperative systemic antibiotic prophylaxis

Abstract

Summary The lower the infection rate in a particular operation, the larger the trial must be to show a benefit of antibiotic prophylaxis. Recently herniorrhaphy, which is considered to be a clean operation, was shown to profit from antibiotic prophylaxis. Perioperative prophylaxis is therefore expected to be used much more widely in the future. The combination of cephazolin and metronidazole is recommended for perioperative prophylaxis because it covers the majority of surgical infections and it is cheap. Preoperative norfloxacin is promising in antibiotic bowel preparation andin the prevention of urinary tract infection following catheterization. Recommended regimens are summarized in Table 1 . Table 1 . Recommendations for perioperative antibiotic prophylaxis. Indication Drug Dose Start Interval All operations Cephazolin 1 g IV At induction 4 h Oropharyngeal, gastro- Metronidazole 1 g IV At induction 8 h intestinal and vaginal Antibiotic bowel Norfloxacin 400 mg orally 5 days before 12 h preparation operation Urinary catheter Norfloxacin 400 mg orally With start of 12 h catheterization