The use of prophylactic antibiotics has become commonplace. Which of the following statement(s) is/are true concerning the prophylactic use of antibiotics?
A. The appropriate use of prophylactic antibiotics must include the initiation of the agent prior to the surgical procedure B. Continuing the antibiotic into the postoperative period has LED to improved results in antibiotic prophylaxis C. The prophylactic administration of broad-spectrum agents (third-generation cephalosporins) has been shown to be particularly advantageous D. The topical use of antimicrobial agents is of no advantage in the prophylactic setting
The appropriate use of prophylactic antibiotics must include the initiation of the agent prior to the surgical procedure-intravenous administration of an antibiotic is clearly indicated for patients undergoing clean contaminated operations. these antibiotics should be administered prior to surgery to obtain adequate tissue levels at the time of potential contamination. however, there has been no added benefit demonstrated for the postoperative use of antibiotics with regard to prophylaxis. the choice of antibiotic is a complex issue which remains unresolved largely because both superficial and deep wound infections can occur as a result of either or both skin (superficial wound) flora (e.g., staphylococcus aureus) and body site (deep wound) infection. for this reason, the administration of agents which possess activity directed against these expected agents is reasonable. although administration of a first-generation cephalosporin is acceptable, second-generation cephalosporins or extended-spectrum penicillins with gram-positive and gram-negative activity and biliary tract excretion may be more suitable for patients undergoing gastrointestinal or biliary tract procedures. similarly, the use of agents with additional anaerobic activity for patients undergoing gastrointestinal procedures involving the small bowel or colon should be considered. the administration of broad-spectrum agents such as third-generation cephalosporins for prophylaxis does not seem to provide additional benefit in comparison to the above-mentioned type antibiotics and may foster the development of resistant organisms within a given institution or superinfection within a given patient. there is evidence that in some cases the topical use of antimicrobial agents is equivalent to the administration of intravenous antimicrobial agent antibiotics.