Abstract:

All too often, it seems that the utilization of antibiotics by surgeons for either prophylaxis or the treatment of established infections is shrouded in a combination of mysticism and marketing. What should be straight forward, frequently becomes confused by factors such as superstition, habit, recent interaction with an industry representative, and faulty information. The rational use of antibiotics is surprising simply, and is based on the fact that these agents are, quite simply, systemic chemotherapy against bacteria.' Once delivered to the patient these agents act not only locally, but, more importantly, sistemically against susceptible microorganisms. This demands that the practitioner make an educated guess as to which bacteria are likely to be present, as well as use an agent that both safe and effective in that specific patient. The types and variety of bacteria present in a surgical infection, or likely to be present, can usually be deduced by the location and/ or organ system involved. The safest and most effective agent to be used against those organisms is primarily a function of the specific hospital that the patient in, and whether the infection is hospitalacquired (nosocomial) or community-acquired. The susceptibility patterns for bacteria vary from community to community (as noted by local hospitals), as well as from hospital to hospital dependent on whether it is a community hospital or a tertiary referral center. It is illogical to assume that the same drug or drugs will be just as effective in one setting as in another, regardless of whether they are used for prophylaxis or an established infection.

Authors:

Robert S. Bennion, M.D., University of California School of Medicine, Los Angeles, CA

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