The Impact of Guidelines on Peri-Operative Antibiotic Administration

Abstract

A survey has shown that peri-operative antibiotic therapy was inappropriate in 83% of patients undergoing abdominal or arterial surgery. Missed doses at induction or postoperatively, a questionable choice of antibiotics and unnecessarily long postoperative courses were major problems. The introduction of formal guidelines was partially successful with appropriate prescribing improving from 17 to 60% of cases. There was, in addition, a marked reduction in prescribing costs.

Antimicrobial prophylaxis in colorectal surgery: a systematic review of randomised controlled trials.

“…It is possible to reduce the cost of antibiotic prophylaxis without adversely affecting SWI rate. [177][178][179][180][181] For example, where appropriate:…”

“…183 A survey on antibiotic prophylaxis in 889 surgical departments in German hospitals found that inappropriate antibiotics were selected 70.5% of the time, and that the duration of prophylaxis was not optimal in 57.1% of cases. 184 In a District General Hospital in England, Dobrzanski and co-workers 179 identified the major problems associated with the use of antimicrobial prophylaxis in abdominal and arterial surgery. These included no antibiotics at induction (35%), questionable antibiotics at induction (22%), questionable postoperative antibiotics (25%), and unnecessarily long postoperative treatment courses (70%).…”

“…The investigators developed the surgical antibiotic prophylaxis guidelines. 179 According to these guidelines, one perioperative and two postoperative doses of cefotaxime (1 g) plus metronidazole (500 mg) should be intravenously administered, in addition to oral neomycin (1 g) plus metronidazole (400 mg) for bowel preparation on the day before abdominal surgery. The antibiotic regimen recommended in these guidelines may not be optimal; for example, a single dose may be enough in many patients.…”

Antimicrobial prophylaxis in colorectal surgery

“…61 62 It may be possible to reduce the cost of antibiotic prophylaxis without adversely aVecting surgical wound infection rate. [63][64][65][66][67] This can be done, for example, by single dose or short term use (less than 24 hours after operation) instead of inappropriate long term use of antibiotics, and by using more eVective and less costly drugs and routes of administration.…”

The involvement of pharmacists in professional and clinical audit in the UK: a review and assessment of their potential role

“…To obtain this information a review of the medical notes is needed to record the circumstances in which a particular medicine is used. Such analyses can provide valuable data on the quality of prescribing (Dobrzanski et al 1991;Sowter et al 1993).…”