SURGICAL

ANTIBIOTICS
 Choice of antibiotics for
prophylaxis
 Benzylpenicillin should be used if
Clostridium infection is a possibility
 Patients with heart valve disease or a
prosthesis should be protected from
bacteraemia caused by dental work,
urethral instrumentation or viscus
surgery
 Principles in the use of
antibiotics
 Given in the ‘decisive period’, they
are useful for prophylaxis
 Only spreading infection or signs of
systemic infection justify the use of
antibiotics
 Whenever possible, the organism
and sensitivity should be determined
Treatment of commensals that
have become opportunist
pathogens

 They are likely to have multiple

antibiotic resistance
 It may be necessary to rotate
antibiotics
 Antibiotics & surgery
 Pseudomonas infection is indicative
criteria reflecting the hygiene of the
hospital.
 Don’t use antibiotics in surgical
infections unless it is spreading.
 In Abscesses after aspiration of the
pus, and returning of G stain and
C&S give the antibiotics accordingly
,when indicated.
 2 Types of antibiotic regime
2. Narrow spectrum (single ) for known
microorganism .i.e.
vancomycine for MRSA

5. Combination
 for unknown microorganism
 For synergistic infection…..triple therapy
 Antibiotics

1. Natural like penicillin

2. Synthetics …most

 Bactericidal ….
Penicillin. Cell wall
Aminoglycoside.. Ribosome
 Bacteriostatic….
Tetracycline, Erythromycine … Cell Division
 Penicillin

G+
Strept.
Clostridia
Staph. (Non B_lactamase)
Actinomyce Spp.
 Ampicillin

 Orally
 Enterobacteriace
 D Strept.
 Amoxicillin + Clavulanic
Acid
 Klebsiella
 E.coli
 Amoxicillin alone must be used for
animal & human bites.
 Mezocillin
 Klibsilla
 Azlocillin
 Pseudomonas
 three generations
first-generation cephalosporins
have excellent activity against
methicillin-susceptible
staphylococci and all
streptococcal species, but not
against enterococci.
The only important difference
between members of the first
generation is in half-life. Cefazolin,
with its longer half-life, can be given
every 8 hours rather than every 4 to 6
hours and maintains more reliable
serum and tissue levels when used
for prophylaxis than do the other
members of this class.
 2nd Generation
The second-generation
cephalosporins have
expanded gram-negative
activity when compared with
the first generation but still
lack activity against many
gram-negative rods.
 Conti…
The most important distinction within the
second generation is between those
antibiotics with good activity against
anaerobes (cefoxitin, cefotetan, and
cefmetazole) and those without important
anaerobic activity (cefamandole, ceforanide,
and cefonicid). Within each of these groups
are antibiotics with relatively short half-lives
(cefamandole and cefoxitin) and with
relatively long half-lives (cefotetan,
cefmetazole, ceforanide, and cefonicid).
 The third-generation
cephalosporins
The third-generation cephalosporins have greatly
expanded activity against gram-negative rods,
including many resistant strains, and rival the
aminoglycosides in their coverage while having a
much more favorable safety profile. In exchange for
this gram-negative coverage, most members of this
group have significantly less activity against
staphylococci and streptococcal species than first-
and second-generation cephalosporins. Anaerobic
coverage is, generally, rather poor as well.
 Continue..
The important distinction in the
third-generation cephalosporins
is between those with significant
activity against Pseudomonas
species (cefoperazone and
ceftazidime) and those without
(cefotaxime, ceftizoxime, and
ceftriaxone).
 Monobactams
 Monobactams. Aztreonam is the only
currently available member of the class of
monobactams. It has gram-negative
coverage, including most Pseudomonas
species, similar to the aminoglycosides,
and like the aminoglycosides lacks
significant activity against gram-positive
cocci and anaerobes. It also lacks activity
against most Acinetobacter species. It has
the safety profile of other beta-lactam
antibiotics but does not cross react in
patients who are allergic to penicillins or
cephalosporins.
 Carbapenems
 Carbapenems. Imipenem is the first
representative of the class of
carbapenems. It has probably the broadest
spectrum of antibacterial activity of any
antibiotic currently available. It has
excellent activity against all gram-positive
cocci except for methicillin-resistant
staphylococci and only modest activity
against enterococci. It is very active
against all anaerobic bacteria
 meropenem
 The second carbapenem,, which is
given without a renal enzyme
inhibitor, has been released in
Europe but not in the United States.
Its spectrum of activity is similar to
that of imipenem.
 Quinolones.
 the fluoroquinolonesLIKE CIPRODAR
,CIP[ROFLOXACINE are marked by
extremely broad activity against
gram-negative rods, including
Pseudomonas species. Most also
have relatively broad activity against
gram-positive cocci, including some
methicillin-resistant staphylococci
 aminoglycoside
 aminoglycosides have very broad activity
against aerobic and facultative gram-
negative rods. They have relatively
indifferent activity against gram-positive
cocci but are an important component of
synergistic therapy against enterococci
when combined with a penicillin or
vancomycin. Aminoglycosides have no
activity against anaerobes or against
facultative bacteria in an anaerobic
environment.
 Toxicity
 Clinically, aminoglycosides are
difficult to use because the ratio of
therapeutic levels to toxic levels is
low, approximately 2:3. The primary
toxicities are nephro and eighth
nerve damage, both auditory and
vestibular
 once-daily
 More recent data suggest that once-
daily administration of
aminoglycosides is as effective as
the more traditional twice or three
times per day administration and is
less toxic
 Metronidazole currently possesses
the most complete activity against all
anaerobic pathogens. However, it
has no activity against any aerobic or
facultative pathogens, either gram
negative or gram positive, so it must
always be combined with another
antibiotic for complete coverage.
 metronidazol
 . Because it has no activity against the
gram-positive cocci, as clindamycin does,
its combination with aztreonam in the
treatment of mixed aerobic and anaerobic
infections leaves this potentially important
group of pathogens uncovered. For this
reason, metronidazole is theoretically
better combined with a third-
generation cephalosporin or a
fluoroquinolone. Metronidazole is
active against Clostridium difficile
 Macrolides
 Macrolides. Erythromycin is a macrolide
antibiotic with only modest antianaerobic
activity in the concentrations that can be
achieved systemically. It has found
widespread use, however, as an oral agent
(erythromycin base) used in combination
with an aminoglycoside to reduce numbers
of bacteria in the lumen of the bowel
before operations on the colon
 Erythromycin is also active against
most gram-positive cocci and
Neisseria species
 sometimes used as an alternate
agent for patients allergic to
penicillins. In addition, it has
significant activity against
mycoplasmas, Chlamydia, Legionella
species, and Rickettsia.
 recent
 Clarithromycin and azithromycin are
two more recent macrolides with
expanded antimicrobial spectra that
are available only in oral formulation
 Tetracyclines
 . Tetracyclines have been an
important class of antibiotics with
significant antianaerobic activity. In
addition to activity against
anaerobes, tetracyclines possess
modest activity against easy gram-
negative rods and many gram-
positive cocci
 Glycopeptides
 Glycopeptides. Vancomycin is the
only glycopeptide antibiotic
available. It is active against
essentially all gram-positive cocci,
especially the methicillin-resistant
staphylococci, for which it is the only
reliable antibiotic. It also has
moderate activity against
enterococci.
 Continue..
 Vancomycin is active against most
Clostridium species, especially C.
difficile, the primary pathogen
responsible for antibiotic-associated
diarrhea. However, it should not be
used as a first-line agent against C.
difficile diarrhea, owing to the risk
that this will increase the incidence
of vancomycin-resistant enterococci