The Chemoprophylaxis of Infection

Antibiotic prophylaxis and the medically compromised patient

“…Antibiotic prophylaxis may be medically, ethically and legally untenable if: 1) the at-risk group to benefit from the prophylaxis cannot be narrowly identified to prevent gross overuse of the antibiotics, 2) prophylaxis is too random in efficacy to be reliable, 3) basic proof for efficacy is too limited, 4) antibiotic prophylaxis causes more harm than the infection to be prevented, 5) the bacteremia to be prevented is too seldom a proximate cause of patient disease, and 6) the antibiotic is aimed at preventing infection by any or all potential microbial pathogens rather than deterring the colonization of a single microbial species (43,269,361).…”

The ethics of prophylactic antibiotics for neurosurgical procedures

“…6 The prophylactic indication of antibiotics rests on the concept that they should eliminate infections in a subclinical stage and prevent one that has not yet started. Antibiotic prophylaxis in neurosurgery began with the use of the antiseptic, hexamine, in 1925 and has continued up to the present time as newer drugs have become available, from penicillin to vancomycin.…”

“…As Dr Weinstein wrote back in 1955, the risk of the development of reactions and the difficulties which they involve must always be taken into consideration in planning a programme of chemoprophylaxis. 6 In cases where the effectiveness of prophylaxis is questionable, the situation must be carefully scrutinised before treatment is started and the benefits to be derived must be weighed against the possible dangers. This requires doctors to take it upon themselves to read the scientific literature.…”

“…A number of placebo-controlled clinical trials have proven the efficacy of antibiotics in preventing wound infection following brain and spine surgery. 2 5 Yet, despite these results, both the prophylactic use and testing of antibiotics for surgical procedures has been a controversial issue since the beginning of the antibiotic era 6 and remains problematic. 7 8 Some neurosurgeons depend upon meticulous aseptic techniques rather than considering antibiotics.…”

Hospital Infections and Their Control: Pitfalls in the Interpretation of Statistical Data*

“…Most investigators concur regarding the limitation of antibiotic therapy, or its discreet use, in selected cases (19, 23). Its effectiveness in the prevention of pneumonia in patients with acute heart failure has been questioned (24).…”