Oral surgery, antibiotics

S woboda S, Oberdorfer K, Klee E, et al. Tissue and serum concentrations of levofloxacin 500 mg administered intravenously or orally for antibiotic prophylaxis in biliary surgery. J Antimicrob Chemother 2003 51 459-462. 

Orally, both antibiotics are used for the treatment of intestinal infections due to susceptible organisms and, in combination with other drugs, for bowel sterilization prior to surgery. Owing to poor absorption from the gastro-intestinal tract, this form of application has rarely led to side-effects. Both are used either alone or in combination with other antibiotics in a variety of ointments and solutions for topical application on infected surface lesions of skin and mucuous membranes " . Allergic reactions have rarely been observed. 

Intravenous antibiotic administration is the most common delivery method for surgical prophylaxis. Intravenous administration ensures complete bioavailability while minimizing the impact of patient-specific variables. Oral administration is also used in some bowel operations. Non-absorbable compounds like erythromycin base and neomycin are given up to 24 hours prior to surgery to cleanse the bowel. Note that oral agents are used adjunctively and do not replace IV agents. 

Table 2. Most commonly used oral and parenteral antibiotics for preoperative bowel preparations before elective colon and rectal surgery in a North American survey [4]... 

Drainage, debridement, and large volume irrigation by 3-directional arthroscopic surgery may become standard treatment for septic arthritis of the hip with concomitant intravenous antibiotics for at least 3 weeks followed by oral antibiotics for at least another 3 weeks. After infectious arthritis is eradicated a follow-up period of 1 years is advised. 

Various antimicrobials agents is used in dentistry for prevention of local oral wound infection and prevention of distant infection i.e., bacterial endocarditis. Generally, prophylaxis by the use of antibiotics is not required for routine type of dental surgery... 

Therapeutic pyramid approach to inflammatory bowel diseases. Treatment choice is predicated on both the severity of the illness and the responsiveness to therapy. Agents at the bottom of the pyramid are less efficacious but carry a lower risk of serious adverse effects. Drugs may be used alone or in various combinations. Patients with mild disease may be treated with 5-aminosalicylates (with ulcerative colitis or Crohn s colitis), topical corticosteroids (ulcerative colitis), antibiotics (Crohn s colitis or Crohn s perianal disease), or budesonide (Crohn s ileitis). Patients with moderate disease or patients who fail initial therapy for mild disease may be treated with oral corticosteroids to promote disease remission immunomodulators (azathioprine, mercaptopurine, methotrexate) to promote or maintain disease remission or anti-TNF antibodies. Patients with moderate disease who fail other therapies or patients with severe disease may require intravenous corticosteroids, anti-TNF antibodies, or surgery. Natalizumab is reserved for patients with severe Crohn s disease who have failed immunomodulators and TNF antagonists. Cyclosporine is used primarily for patients with severe ulcerative colitis who have failed a course of intravenous corticosteroids. TNF, tumor necrosis factor. 

A single dose of IV cefazolin will provide adeqnate prophylaxis for most cases. Oral ciprofloxacin may be used for patients with j8-lactam hypersensitivity. Postoperative therapeutic antibiotics may be indicated if perforation is detected during surgery, depending on whether an established infection is present. 

There is a preponderance of evidence that the incidence of postoperative endophthalmitis is reduced when antiseptics (povidone iodine) and antibiotics are used preoperatively.The use of balanced salt solution, to which an antibiotic has been added, to irrigate the eye during surgery is advocated by some but tempered by concerns of intraocular toxicity and questions of efficacy. Sub-Tenon s capsule injection of an antibiotic just before surgery or subconjunctival injection of antibiotic at the end of the surgery is also used to prevent infection, but risk of inadvertent intraocular injections resulting in retinal antibiotic toxicity must be considered. In addition, oral antibiotics may be used at the time of surgery and 1 day postoperatively as a prophylactic measure. 

Despite apparently adequate surgery and antibiotics, some patients may fail therapy and have recurrent relapses in their infection. This scenario is more common in the population with chronic osteomyelitis. These patients may require long-term oral antibiotics in order to keep the infection under control. 

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