There are numerous antibiotics available for use in the surgical patient. However, certain antibiotics are used before, during and/or after surgical procedures for very specific reasons. It is essential that physicians and nurses are familiar with these medications and fully understand the indications that call for the use of these medications. Additionally, it is important that health care providers ensure that patients understand the common risks and contraindications of these antibiotics used with surgery.
Antibiotics commonly used with surgical procedures:
Antibiotics used to treat anaerobic infections are often used for operations that involve the abdominal cavity. Metronidazole, also known as Flagyl, is commonly used for treating and preventing anaerobic infections. Flagyl can also treat parasitic infections such as amebiasis. Clindamycin is another antibiotic used for intra-abdominal surgeries, though this antibiotic may create a greater risk of developing C. difficile diarrheal infection. “Clinda” has strong anaerobic gram negative activity as well as some activity again gram positive bacteria.
Other common antibiotics used in the prevention or treatment of anaerobic infections in surgical patients are cefoxitin, Unasyn (ampicillin and sulbactam), Augmentin (amoxicillin and clavulanic acid), cefotetan, and ticarcillin-clavulanic acid.
On occasion, antibiotics are required that can treat mixed infections containing both anaerobic and aerobic bacteria. The second-generation cephalosporin Cefoxitin (or Mefoxin) is sometimes used for this purpose. It is effective against aerobic bacteria as well as the gram negative anaerobe Bacteroides fragilis and other anaerobes.
Pre- or post-operative infections that are caused by gram negative bacteria require the use of antibiotics that are particularly effective against gram-negatives. These antibiotics include Gentamycin and other aminoglycosides, ciprofloxacin, third-generation cephalosporins, aztreonam and sulfamethaxozole-trimethoprim (Bactrim or Septra). Gentamycin must be used with caution due to potentially toxic effects on the kidneys.
Pseudomonas is a gram-negative bacteria that can cause a variety of potentially lethal infections in a surgical patient. Ciprofloxacin is a broad spectrum quinolone antibiotic that has activity against Pseudomonas. Importantly, ciprofloxacin or “Cipro” cannot be given to pregnant women or young children because it interferes with the growth plates of the bones. The third generation cephalosporin Ceftazidime or “Ceftaz” also has strong antibiotic activity against Pseudomonas.
In contrast to the potent third generation cephalosporin Ceftaz, first-generation cephalosporin antibiotics are commonly used as surgical prophylaxis (prevention) of infections caused by normal skin bacteria. Cephazolin, also known as Ancef, is frequently given before surgery for this particular indication.
Importantly, there are certain antibiotics commonly used in a surgical patients that require blood levels are checked periodically. This is required with the use of aminoglycosides such as Gentamycin, and intravenous Vancomycin. Intravenous Vancomycin is often reserved for use in individuals who are known to have methicillin-resistant Staphylococcus aureus or MRSA. When used orally, Vancomycin can treat Clostridium difficile (C. diff) infection in hospitalized patients, a condition also known as pseudomembranous colitis.
There are numerous antibiotics used in patients either before, during or after surgical procedures. These antibiotics are specifically chosen based on the spectrum of antibiotic activity that each drug provides as well as any common adverse effects or contraindications. Patients and health care providers should work together to determine which antibiotic medication is most appropriate on an individual basis.
Source: Blackbourne, L. Surgical Recall. 3rd Ed. 2002.
