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ANTIBIOTICS PROPHYLAXIS IN SURGERY

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  • It should be given at induction or upto 30 minutes before surgery.
  • The following are the different types of surgeries and antibiotics coverage that is to be done accordingly:
  1. Surgery of Gastric/Oesophageal surgery: The most common pathogens found are Enteric gram negative bacilli, gram positive cocci. Thus the antibiotics of choice would be single does of Gentamicin IV (First line) or Cefuroxime IV or Co-amoxicalv IV.
  2. Colorectal surgery: The most common pathogens are Enteric gram negative bacilli, enterococci, anaerobes. Hence the preferred antibiotics include single does of Gentamicin IV +metronidazole Iv/PR or Cefuroxime IV +metronidazole Iv or Co-amoxicalv IV alone.
  3. Appendicectomy: The most common pathogens are Enteric gram negative bacilli, enterococci, anaerobes. Hence the preferred antibiotics include single does of Gentamicin IV +metronidazole Iv/PR or Cefuroxime IV +metronidazole Iv or Co-amoxicalv IV alone.
  4. Open Biliary Surgery: The most common pathogens are Enteric gram negative bacilli, enterococci, clostridia. Hence the preferred antibiotics include single does of Gentamicin IV +metronidazole Iv/PR or Cefuroxime IV +metronidazole Iv or Co-amoxicalv IV alone.
  5. ERCP: The most common pathogens are Enteric gram negative bacilli, enterococci, clostridia. Thus the antibiotics of choice would be single does of Gentamicin IV (First line) or Ciprofloxacin IV/PO.
  6. Vascular surgery: The most common pathogens are S. aureus, S. epidermidis, anaerobes in diabetes, gangrene or undergoing amputaion. So the antibiotic of choice is Single dose of cefuroxime IV or Flucloxacillin IV+ gentamicin IV. Add metronidazole for suspected anaerobic infection.
  7. Lower limb amputation/major truma: The antibiotics of choice are Co-amoxiclav alone or (for penicillin allergy) cefuroxime IV + metronidazole 400-500 mg tds.
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