Antibiotic Prophylaxis in Surgery - SIGN guideline

Question 1

For which gynae procedures are prophylactic antibiotics ‘highly recommended’ - ie should be given

Answer 1

• Caesarean Section (OR 0.41, NNT 19)

- Induced abortion (OR 0.58, NNT 25)

Question 2

For which gynae procedures are prophylactic antibiotics ‘recommended’?

Answer 2

• Abdominal hysterectomy
• Vaginal hysterecomy (OR 0.17, NNT 4)
• 3rd/4th degree perineal tear repair
• MROP (with chlamydia/gonorrhoea)

Question 3

For which gynae procedures should prophylactic antibiotics ‘be considered’?

Answer 3

MROP

Question 4

For which gynae procedures are prophylactic antibiotics ‘not recommended’? (i.e. not effective)

Answer 4

• Assisted delivery
• Evacuation of incomplete miscarriage
• IUCD insertion

Question 5

What is a ‘clean’ wound?

Answer 5

No inflammation encountered

Resp/alimentary/GU tract not entered

Question 6

What is a ‘clean contaminated’ wound?

Answer 6

Resp/alimentary/GU tract entered but without significant spillage

Question 7

What is a ‘contaminated’ wound?

Answer 7

Operations where acute inflammation (without pus) is encountered, or where there is visible contamination of the wound.

Question 8

What is a ‘dirty’ wound?

Answer 8

Operations in the presence of pus, where there is a previously perforated hollow viscus, or compound/open injuries more than four hours old.

Question 9

What is the estimate of clostridium difficile infection following abx prophylaxis?

Answer 9

0.2-8%

Increased with 3rd generation cephalosporins and multiple doses

Question 10

When should prophylactic antibiotics be given (ie timing?)

Answer 10

Within 60mins prior to skin incision (vanc - 90mins)

Question 11

When should a further dose of prophylactic abx be given?

Answer 11

When over 1.5L blood loss

Operation to take longer than 4 hours

Question 12

Which antibiotics are most effective against staph aureus?

Answer 12

30-60% susceptible to flucloxacillin, macrolides and clindamycin

Question 13

Which antibiotics are most effective against beta haemolytic streptococci?

Answer 13

90% susceptible to penicillins, macrolides, clindamycin

Question 14

Which antibiotics are most effective against anaerobes?

Answer 14

95% susceptible to metronidazole and co-amoxiclav (NOT penicillins)

Question 15

Which antibiotics are most effective against E. Coli and other enterobacteriaceae?

Answer 15

Complex resistance problems. However, approximately
80-90% of E. coli remain susceptible to second generation cephalosporins, beta-lactam drugs combined with a beta-lactamase inhibitor, or gentamicin