Abstract
Compared with systemic antibiotic therapy, the topical or local delivery of an antibiotic has many potential advantages. However, local antibiotics at the surgical site have received very limited approval in any of the surgical prophylaxis consensus guidelines that we are aware of. A review of the literature was carried out through searches of peer-reviewed publications in PubMed in the English language over a 30 year period between January 1980 and May 2010. Both retrospective and prospective studies were included, as well as meta-analyses. With regard to defining 'topical' or 'local' antibiotic application, the application of an antibiotic solution to the surgical site intraoperatively or immediately post-operatively was included. A number of surgical procedures have been shown to significantly benefit from perioperative topical prophylaxis, e.g. joint arthroplasty, cataract surgery and, possibly, breast augmentation. In obese patients undergoing abdominal surgery, topical surgical prophylaxis is also proven to be beneficial. The selective use of topical antibiotics as surgical prophylaxis is justified for specific procedures, such as joint arthroplasty, cataract surgery and, possibly, breast augmentation. In selective cases, such as obese patients undergoing abdominal surgery, topical surgical prophylaxis is also proven to be beneficial. Apart from these specific indications, the evidence for use of topical antibiotics in surgery is lacking in conclusive randomized controlled trials.
Highlights
Surgical site infection (SSI) accounts for 20% of all healthcareassociated infections.[1]
Studies of topical cephalosporin use in gallbladder surgery reported that topical antibiotics should not be used on their own as prophylaxis,[23] especially in patients at high risk of SSI.[24]
On clinical follow-up, no significant differences were observed between patients who were given topical antibiotics and those administered intravenous prophylaxis
Summary
Surgical site infection (SSI) accounts for 20% of all healthcareassociated infections.[1]. There are many interventions advocated to reduce SSI, including pre-operative assessment to optimize underlying disease such as diabetes mellitus, aseptic techniques in the operating theatre and the use of systemic prophylactic antibiotics.[7,8,9]
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