[Antibiotic prophylaxis: definition and documentation]

Abstract

Controlled, randomized and prospective studies were reviewed to evaluate the value of antibiotic prophylaxis in colonic and biliary tract surgery as well as in the treatment of open fractures. --Colorectal surgery: 7 studies using oral and 3 using parenteral antibiotics in addition to extensive bowel preparation have demonstrated the importance of a short term prophylaxis, instituted before surgery and discontinued soon thereafter. Different antibiotics with aerobic or anaerobic spectra reduced the incidence of wound infections significantly; further improvement could be expected from combinations covering both spectra. --Biliary surgery: cefazolin, gentamycin and rifamycin--used in four controlled studies--were effective in reducing infectious complications. No distinction was made between patients of different infectious risks. In low risk gallbladder surgery the real value of antimicrobial prophylaxis is unknown. Short term prophylaxis is recommendable in all high risk patients undergoing surgery and in the low risk case submitted to extensive interventions. --Open fractures: only three authors have submitted their patients to controlled studies. All protocols suffered from some bias. No definite conclusions can be made. The authors' personal recommendations are: no prophylaxis in first degree injuries; early preoperative administration of penicillinase-resistant drugs in second and third degree lesions.