Are you using preoperative antibiotics correctly? Appropriately administered prophylactic antibiotics reduce the risk of surgical site infection (SSI). SSIs are the most common and costliest health care-associated infections. SSIs have an enormous impact on patients’ quality of life and contribute substantially to the financial cost of patient care. How do you manage perioperative antibiotic administration? Do you have a guide to help you properly mix, dilute, and correctly time your antibiotic administration?
The Centers for Disease Control and Prevention (CDC) have noted that 30-50% of all antibiotics given in the United States are either unnecessary or inappropriate. Perioperative antibiotic management is a great opportunity to enhance patient safety as well as antibiotic stewardship. The goal of giving antibiotics prior to incision is to allow enough time for the antibiotic to disperse through the tissues and reach optimal concentrations at the site of surgery.
Which antibiotic is best for preop prophylaxis?
Antibiotic choice and route of administration is going to vary based on the surgery site and the procedure being performed. Is it an ophthalmic procedure, gastrointestinal, orthopedic, vascular, or obstetric/gynecologic? In some procedures the antibiotic is applied topically, such as in ophthalmic procedures. For others, they are administered intravenously, which we will cover in more detail below. It is always recommended to check the applicable guidelines ahead of time. Your consultant pharmacist should be able to point you in the right direction. You can always reach out to us for case specific guidance.
When should antibiotics be given?
The timing and administration of appropriate antibiotics is very important to successful prevention of SSIs. The consensus from the guidelines is that the antibiotic should be administered ideally within 60 minutes of the time of incision, with most surgeons opting for within 30 minutes of incision. Vancomycin and fluoroquinolones may be started up to 120 minutes before surgery due to extended infusion times and long half-lives. Intraoperative redosing is sometimes required based on the duration of the procedure. The recommendations for cefazolin (Ancef/Kefzol), which is the most commonly used antibiotic, is to dose it every 4 hours.
What are the alternatives for patients with allergies?
A careful evaluation of patient allergies is part of the decision-making process. As always, document clearly and consistently the drug allergy and the corresponding reaction. Once clearly determined, the decision can be made on the use of alternative agents. Avoid giving cefazolin if the patient has allergies to cephalosporins or a life-threatening allergy to penicillin.
Alternatives for patients with a true penicillin allergy (angioedema, bronchoconstriction, cardiac arrhythmias, hypotension, or respiratory distress) include clindamycin and vancomycin.
How to prepare intravenous antibiotics:
So, the patient has been assessed, allergies have been documented and the reaction clarified, the physician has ordered the appropriate antibiotic based on the procedure and guidelines…you’re all set, right? Almost! You may still need to mix, dilute (when applicable) and administer the antibiotic. Where do you start? I suggest you have a summary reference tool to help make the job easier. The last thing you need is to panic or spend time researching how to reconstitute the antibiotic, does it need to be diluted, does it go IM or IV, how long should you run it for, what precautions must you take and what about monitoring parameters, at the time of administration. If you’re one of our clients, you already know the answer…we provide a two-page reference guide with all the answers for easy preparation and administration of the most commonly used antibiotics. If you’re not one of our clients, or if you just have a question, we’d still love to help you. Please reach out and we will point you in the right direction.
The Consultant Pharmacists at OctariusRx provide guidance on safe medication management, survey readiness and cost savings to ambulatory healthcare facilities/surgery centers, senior care facilities and pharmacies. We also help individual patients optimize their medications to improve their quality of life and save money. Contact us for assistance.
