Antimicrobial prophylaxis

Antimicrobial prophylaxis if ascites/cirrhosis present preferably before endoscopy... 

Identify your treatment goals for JJ in terms of antimicrobial prophylaxis. 

Create a plan for JJ s antimicrobial prophylaxis, making sure to compare and contrast the pros and cons of the different agents for this patient. 

Close contacts of patients with CNS infections should be evaluated for possible antimicrobial prophylaxis. 

High-dose penicillin G traditionally has been the drug of choice for the treatment of pneumococcal meningitis. However, due to increases in pneumococcal resistance, the preferred empirical treatment now includes a third-generation cephalosporin in combination with vancomycin.13 All CSF isolates should be tested for penicillin and cephalosporin resistance by methods endorsed by the CLSI. Once in vitro sensitivity results are known, therapy may be tailored (Table 67-3). Patients with a history of type I penicillin allergy or cephalosporin allergy may be treated with vancomycin. Treatment should be continued for 10 to 14 days, after which no further maintenance therapy is required. Antimicrobial prophylaxis is not indicated for close contacts. 

Describe the role of antimicrobial prophylaxis and/or vaccination for gastrointestinal infections. 

Discuss the importance of timing, duration, and redosing in relation to antimicrobial prophylaxis in surgery. 

Discuss the possible impact of antibiotic-impregnated bone cement and how this affects the use of antimicrobial prophylaxis in surgery. 

Studies have not shown benefit for additional doses of antibiotic and the duration of antimicrobial prophylaxis should not exceed 24 hours. 

Surgical operations are classified as clean, clean-contaminated, contaminated, or dirty. Antimicrobial prophylaxis is appropriate for clean, clean-contaminated, and contaminated operations. Dirty operations take place in situations of existing infection and antimicrobials are used for treatment, not prophylaxis (Table 82-1). 

From Kanji S, Devlin JW. Antimicrobial prophylaxis in surgery. In DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw-Hill 2005 2219, with permission.)... 

The National Surgical Infection Prevention Project and published evidence suggest that the continuation of antimicrobial prophylaxis beyond wound closure is unnecessary.1 Studies have not shown benefit for additional doses of antibiotic and the duration of antimicrobial prophylaxis should not exceed 24 hours. Longer durations of antibiotic prophylaxis are advocated by some guidelines and will be discussed later. 

TABLE 82-3. Recommended Regimens for Antimicrobial Prophylaxis of Specific Surgical Procedures3... 

Cefazolin or cefuroxime are appropriate for prophylaxis in cardiothoracic and vascular surgeries. In the case of 3-lactam allergy, vancomycin or clindamycin are advised. Debate exists on the duration of antimicrobial prophylaxis. The National Surgical Infection Prevention Project cites data that extending prophylaxis beyond 24 hours does not decrease SSI rates and may increase bacterial resistance.1 American Society of Health-System Pharmacists guidelines from 1999 allow for the continuation of prophylaxis for up to 72 hours.22 Duration of therapy should be based on patient factors and risk of development of an SSI. SSIs are rare after cardiothoracic operations, but the potentially devastating consequences lead some clinicians to support longer periods of prophylaxis. 

Appendectomy is one of the most common intra-abdominal operations. Antimicrobial prophylaxis used for appendectomy is similar to that used for colorectal regimens. In the case... 

The goal of antimicrobial prophylaxis in dental procedures is to prevent endocarditis. According to American Heart Association guidelines, at-risk individuals should receive 2 g of amoxicillin 1 hour prior to the procedure.23 Patients with a (5-lactam allergy may receive clindamycin 600 mg 1 hour prior to the procedure. Interested readers should refer to the American Heart Association guidelines for a complete discussion on risk stratification and recommendations. 

Major breaks in surgical technique may cause the classification of the operation to change and require adjustments in antimicrobial prophylaxis. 

American Society of Health-System Pharmacists. ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery. Am J Health-Syst Pharm 1999 56 1839-1888. 

Bratzler DW, Houck PM, for the Surgical Infection Prevention Guideline Writers Workgroup. Antimicrobial prophylaxis for surgery an advisory statement from the National Surgical Infection Prevention Project. Am J Surg 2005 189 395-404. 

Weed HG. Antimicrobial prophylaxis in the surgical patient. Med Clin North Am 2003 87 59-75. 

Antimicrobial prophylaxis Antibiotics given to prevent an infection. 

---