Ludwig K A, Carlson M A, Condon R E
Department of Surgery, Medical College of Wisconsin, Milwaukee 53226.
Annu Rev Med. 1993;44:385-93. doi: 10.1146/annurev.me.44.020193.002125.
Prophylactic antibiotics can decrease the incidence of postoperative wound infections in indicated procedures. The accepted indications for administering prophylactic antibiotics have been clean-contaminated procedures and prosthesis insertion, but new indications are evolving that consider wound contamination together with anesthetic risk and relative duration of the operation. A prophylactic antibiotic is chosen on the basis of its activity against endogenous flora likely to be encountered, its toxicity, and its cost, in that order. Potent antibiotics used for serious infections are generally not used for prophylaxis. A maximum dose of a prophylactic antibiotic is given preoperatively so that effective tissue concentration is present at and after the time of incision. In the absence of infection, antibiotics should not be continued beyond the operative day. Regimens for specific procedures are discussed.
预防性抗生素可降低特定手术中术后伤口感染的发生率。预防性使用抗生素的公认指征为清洁-污染手术和假体植入，但新的指征正在形成，即综合考虑伤口污染、麻醉风险和手术相对时长。选择预防性抗生素时，依次依据其对可能遇到的内源性菌群的活性、毒性和成本。用于严重感染的强效抗生素一般不用于预防。术前给予预防性抗生素最大剂量，以便在切开时及切开后组织中存在有效的药物浓度。若无感染，术后不应继续使用抗生素超过手术当日。文中讨论了特定手术的用药方案。
