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A-lntrsdsellsn
1-. prophylaxis: Administering the putative agent before bacterial contamination
occurS
2. Early therapy: lmmediate or prompt institution of therapy as soon as the patient
presents; usually contamination or infection will have preceded the initiation of therapy (e'9.,
dirty wounds)
B.
c. lnd,ieatisnsle"rSuraeaj-p'_rsphvlaxis"i
o. Pnneiples-qt.P"rsBhylaxisi
1. preoperative- dose timins: Since antibiotics must be present in the tissues at the time of
bacterial contamination (incision) and throughout the operative period; "on-call" dosing is not
acceptable, therefore:
l. the optimal time for administration of preoperative doses is within 60 minutes
before surgical incision. This is a more specific time frame than the previously recommended
time, which Was "at induction of anesthesia" however, Some agents such as
fluoroquinolones and vancomycin , require administration over 1 to 2 hrs; therefore the
administration of these agents should begin within 120 minutes before surgical incision.
ll. Antibiotics should be re-dosed if:
o Surgical procedures lasts longer than 4 hours ( or more than 2 half-lives of
antibiotic).
o There is excessive blood loss during procedure.
o lf there are other factors that may shorten the half-life of the prophylactic
agent (e.g. extensive burns)'
o Readministration of the drug may be also warranted in patients in whom the
half-life of the agent may be prolonged (e.g. patients with renal insufficiency or
failure)
2. Duration of proPhvlaxis:
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