Prophylactic antibiotics infection control

Critically ill patients are at high risk for a variety of nosocomial infections. Knowledge of infection control techniques, as well as proper use of prophylactic and empiric antibiotics, is an important component of critical care pharmacy practice. Inappropriate antibiotic use can lead to antimicrobial resistance and outbreaks of nosocomial infection that are difficult to treat with conventional therapies. Critical care pharmacists work with infection control staff and infectious disease pharmacists to optimize the use of antimicrobial therapies. 

Controlled studies have not shown benefits definitively with prophylactic antibiotics for noninfected bites. Because up to 20% of bite wounds may become infected, a 3- to 5-day course of antimicrobial therapy generally is recommended. This is especially important for patients at greater risk for infection (patients older than 50 years of age and those with puncture wounds and wounds to the hands, and... 

Although there is no substitute for good infection control practices in a rigid surgical environment, the controversy over prophylactic antibiotics continues (35). As a general rule, antibiotics have been used in pacemaker and ICD procedures because the risk of infection carries an extreme monetary penalty (36-38). It is well known that surgical procedures that are prolonged are associated with increased risk of infection. Unfortunately, the literature does not reflect any specific requirements with respect to antibiotic prophylaxis in pacemaker and ICD procedures (39). 

Historically, antibiotics have been employed prophylactically and curatively to treat bacterial infections in aquaculture systems, in particular in the hatchery environment. Sulfamerazine has been used in US aquaculture since 1948 and antibiotics in general have undoubtedly been instrumental in the commercial success of many aquaculture hatcheries (Alderman and Michel, 1992). However, few antibiotics have been approved by authorities for use in seafood aquaculture and most are restricted to experimental use, or are used off-label (Lucchetti et al, 2004). Indeed, in the USA only four antibiotics have been approved for use in aquaculture - oxytetracycline, florfenicol, ormethoprim/sulfadimethoxine and sulfamerazine - whereas in Japan over 30 antibiotics have been approved for use in aquaculture (Reimschuessel and Miller, 2006). Although antibiotics are effective control measures, there are significant environmental consequences relating to... 

It should be mentioned that the antagonistic modes of action of these microbiological control strategies are not a direct replacement of antibiotics in the event of an infection. Their prophylactic application is, however, said to lead to a considerable reduction in infection risk. Although their effectiveness has become generally accepted in the aquaculture world, the exact mode of action of several microbiological approaches has not yet been unequivocally established. 

---