Prophylactic Antibiotics: Are They Really Essential?
What Are Prophylactic Antibiotics?
Prophylactic antibiotics are drugs that are prescribed for the prevention of infection. Patients may be recommended to undergo prophylaxis if the surgical procedure or their health condition is associated with a risk of the occurrence of infection or if a potential postoperative infection would be quite dangerous for the patient’s well-being.
Prophylaxis is the standard procedure for various types of surgeries (contaminated, clean-contaminated, clean, and dirty procedures), including those involving insertion of special devices. The aim of prophylactic antibiotics is the prevention of a range of infections, such as urinary tract infections, local wound infections, pneumonia, and others.
When Should Prophylactic Antibiotics Be Used?
The following procedures require the use of prophylactic antibiotics for preventing various health problems:
• Biliary tract procedures; • Gynecologic and obstetric procedures; • Urologic procedures; • Orthopedic procedures; • Noncardiac vascular procedures; • Hernia and breast procedures; • Thoracoscopic and laparoscopic procedures.
How to Choose the Right Prophylactic Antibiotic?
The particular antibiotic for prophylaxis is chosen based on different factors, including the kind of infection that may occur due to certain types of surgery, costs of agents, and others. For instance, in the case of certain gastrointestinal procedures, the risk of the occurrence of gram-negative and/or anaerobic bacterial infections is high, which means that it is important to use antibiotics for preventing the occurrence of the mentioned infections.
The following are main factors that should be taken into consideration:
• The effectiveness of an antibiotic against microorganisms causing infection; • The ability to reach the needed tissue levels; • The potential to cause side effects: • Reasonable cost; • Hospital environment.
Usually, prophylactic antibiotics should be taken within twenty-four hours after surgery. This is needed to prevent the occurrence of various undesirable side effects or other problems. Some surgeries require the use of antibiotics for a longer period of time. The following side effects may be the cause of too long use of prophylactic antibiotics:
• Stomach aches; • Severe diarrhea; • Antibiotic resistance.
It is extremely important to use such antibiotics at the right time. The first dose of a chosen drug should be given before the procedure. Usually, it is recommended to take it within thirty minutes before the operation. Generally, the administration after the surgery is not recommended.
Before you are prescribed with a certain antibiotic for prophylaxis, you should tell your healthcare provider if you use any other medications, which is important to avoid drug interaction.
If you do not have an urgent surgery, you can talk to your healthcare provider and find out all the relevant information on a particular prophylactic antibiotic, such as side effects, warnings, drug interaction, etc.
What Medications Can Be Used for Prophylaxis?
The needed medication is chosen only by your healthcare provider based on a range of factors, but the following are the most commonly used drugs for prophylaxis:
• Sulfamethoxazole/trimethoprim; • Cipro I.V.; • Bactrim; • Ciprofloxacin; • Co-trimoxazole; • Bactrim DS; • Cipro; • Septra DS; • Sulfatrim; • Septra; • Invanz; • Cipro XR; • Ertapenem; • SMZ-TMP DS; • Sulfatrim Pediatric; • Cotrim, and others. wha
Is It Really Essential to Use Prophylactic Antibiotics?
One of the reasons for the use of prophylactic antibiotics is aiming at preventing postoperative wound infections. These infections can cause a range of negative consequences, including increased pain, sepsis, or even death. Also, it is pretty expensive to treat these infections, which may significantly decrease patient's budget. According to statistics, about 1 million patients suffer from wound infections every year in the USA. The infection expands the length of hospital stay by seven days, increasing the expenses of a patient by 20%.
The following conditions increase the risk of the occurrence of bacterial infections:
• Diabetes; • Extremes of age; • Use of corticosteroid; • Recent surgery; • ASA class 3-5; • Obesity; • Malnutrition; • Massive transfusion; • Several comorbid diagnoses; • Removing hair with razor; • History of irradiation of site; • Electrocautery; • Foreign body; • Wound drains; • Injection with epinephrine.
Patients who have two or more risk factors can be recommended to use prophylaxis but not strongly indicated. Prophylaxis is not necessary for superficial or cutaneous soft tissue procedures.
The Use of Prophylactic Antibiotics by Children
Prophylactic antibiotics may be recommended for the use by children for preventing the following conditions:
• Neonatal ophthalmia due to Chlamydia trachomatis or/and Neisseria gonorrhoeae; • Endocarditis following dental procedures in high-risk groups; • Endocarditis following genitourinary and gastrointestinal procedures; • Postoperative wound infection; • Recurrent otitis media; • Recurrent urinary tract infection.
In many cases, the use of prophylactic antibiotics by children is recommended, but they should not be overused.