Antibiotic Utilization for Surgical Prophylaxis in a Tertiary Care Teaching Rural Hospital

Introduction

The discovery of antibiotics is a remarkable achievement of the twentieth century. Prior to the antibiotic era, patients who contracted common infectious diseases had significant morbidity and mortality. The discovery of penicillin in 1927, followed by subsequent discovery of other antibiotics, contributed to a significant decline in infectious disease mortality (Oliphant & Madaras-Kelly, 2008). Antibiotics are effective for the control as well as cure of serious infections. Antibiotic prophylaxis should be used where efficacy has been demonstrated and benefits outweigh the risk. Antibiotic prophylaxis is divided into surgical prophylaxis and nonsurgical prophylaxis (Lampiris & Maddix, 2009).

Surgical antibiotic prophylaxis is defined as the use of antibiotics to prevent surgical site infections (Tripathi, 1999). Surgical procedures can be categorized into four classes (Table 1) with an increasing incidence of bacterial contamination and subsequent incidence of postoperative infection (Culver et al., 1991). Rationally used antibiotic prophylaxis reduces the incidence of surgical wound infection. Prophylaxis is uniformly recommended for all clean-contaminated, contaminated and dirty procedures. It is optional for the clean procedures, although it may be indicated for certain patients and clean procedures that fulfill specific risk criteria (Henry, 2006). Irrational antibiotic prophylaxis leads to excessive surgical wound infection and increase of drug resistance. Common errors in antibiotic prophylaxis include selection of the wrong antibiotic, administering the first dose too early or too late, failure to repeat doses during lengthy procedures, prolonged duration of postoperative prophylaxis, and injudicious use of broad spectrum antibiotics (Lampiris & Maddix, 2009).