QuestionSBA
QuestionChoice
IV gentamicin is commonly used for perioperative prophylaxis in urological surgeries
32976
d
IV gentamicin
QuestionChoice
Oral antibiotics are less appropriate than the intravenous route as antibiotic prophylaxis before a major operation
32974
b
Oral co-amoxiclav
QuestionChoice
Intravenous antibiotic therpay is important for surgical prophylaxis in many major surgeries. Different health care systems may recommend different antibiotics for different surgeries however IV co-amoxiclav is a common regime for abdominal surgery
32973
a
Intravenous co-amoxiclav
QuestionChoice
Nasal mupirocin 2% (Bactroban Nasal®) is often used for MRSA eradication prior to hospital admission
32977
e
IV mupirocin
QuestionChoice
This is the usual regime for suspected intra-abdominal sepsis
32975
c
Intravenous amoxicillin, metronidazole and gentamicin
Concept
Chapter
# Summary

Peri-operative antibiotics are utilized to prevent postoperative wound infections in numerous surgical procedures, including those involving implantation of prostheses, contaminated or dirty procedures, thoracic procedures, most gastrointestinal, hepatobiliary, urological, open fracture repairs, and vascular surgeries. They are typically administered intravenously within 1 hour prior to the incision. The specifics regarding when and which antibiotics should be used are outlined in the SIGN Guideline 104.

# Definition

Peri-operative antibiotics are prophylactic antimicrobial agents administered during the perioperative period, specifically within 1 hour prior to the surgical incision, with the primary goal of reducing the risk of postoperative wound infections.

# Aetiology

The need for peri-operative antibiotics arises from the risk of bacterial contamination during surgery, potentially leading to postoperative wound infections. This risk is exacerbated in procedures involving foreign bodies such as prosthetics, or in surgeries that involve opening body cavities, like the thorax or abdomen, which may expose the surgical field to the natural bacterial flora of these sites.

# Signs and Symptoms

While the use of peri-operative antibiotics is a preventative measure and not symptom-based, the signs and symptoms of a failed prophylaxis (i.e., a postoperative wound infection) may include:

-   Redness and swelling at the surgical site
-   Increased local temperature
-   Purulent discharge
-   Pain at the surgical site
-   Fever
-   Other systemic signs of infection

# Differential Diagnosis

Differential diagnoses for postoperative wound infection may include:

-   Seroma: Fluid accumulation, typically presenting as a fluid-filled swelling at the surgical site with no signs of infection.
-   Hematoma: Accumulation of blood, presenting with a swelling or mass-like effect at the surgical site, often painful but without signs of infection.
-   Suture reaction: Localized inflammation due to the body's immune response to suture materials, often presenting with redness and swelling, but no purulent discharge or systemic signs of infection.

# Investigations

Investigations related to the use and effectiveness of peri-operative antibiotics primarily focus on identifying postoperative wound infections. They may include:

-   Physical examination of the surgical site
-   Culture and sensitivity of wound discharge
-   Blood investigations, such as Full blood count (FBC) and inflammatory markers (CRP, ESR)

# Management

Management strategies of peri-operative antibiotics focus on:

-   Administration of antibiotics within 1 hour before incision
-   Selection of appropriate antibiotic, taking into account the likely contaminating organisms and patient allergies
-   Review of the need for ongoing prophylaxis beyond the initial doses
-   Monitoring for signs of postoperative wound infection
-   Management of identified infections, including culture-guided antibiotic therapy

# References

[Click here for a summary of SIGN guideline 104 on the use of peri-operative antibiotics](https://www.nhstaysideadtc.scot.nhs.uk/Antibiotic%20site/pdf%20docs/Antibiotic%20prophylaxis%20in%20gen%20surgery.pdf)
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Perioperative antibiotics
Topic
7
General Surgery
6595
A 62-year-old man is about to undergo a pancreatectomy.

Which antibiotic regime should be considered before the surgery?
a