Antibiotikaprophylaxe in der Gallenwegchirurgie

Abstract

Antibiotic prophylaxis for laparoscopic operations of the biliary tree follows the same rules as traditional open biliary surgery. While there is a sufficient number of publications on phase I studies investigating antibiotic prophylaxis of gallstone disease in prospective randomized trials, the information about more complicated and uncommon biliary tree operations is scarce. Therefore my recommendations are based on available data from phase I studies concerning calculus disease, and I assume that the results of these studies similarly apply to uncommon procedures of the biliary tract. Specifically, the antibiotic should be given 45 ± 15 min before skin incision is done. A single dose is sufficient in more than 95% of the cases, and the bacteria to be covered are those that are known to cause postoperative infection. They are different from the bacteria recovered from the biliary tree. If the operation lasts for more than 2 h and the half-life of the antibiotic of choice is less than 60 min, a second dose should be administered exactly 2 h after the first dose and never after termination of the operation and closing of the skin. The best antibiotic choices are a single dose of 2 grams of cefotaxime, cefmenoxime, or ceftizoxime. Ceftriaxone qualifies only for operations that last longer than 8 h, because of its long half-life. Few studies indicate that the quinolones may be similarly effective in biliary surgery. Aminoglycosides and modern penicillins or penicillin beta-lactamase inhibitors in combination are less effective.