Cephalosporins in Surgical Prophylaxis
Cephalosporins in Surgical Prophylaxis
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DOI：
10.1179/joc.2001.13.supplement-2.23
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发表时间：
2001-11-01
影响因子：
1.8
通讯作者：
Kadas, B.
中科院分区：
文献类型：
--
作者：
Geroulanos, S.;Marathias, K.;Kadas, B.
对照临床试验表明，抗菌预防可以降低某些手术后感染的发生率，从而减少发病率、住院时间、抗生素使用和败血症死亡率。有效的预防方案应针对最可能感染的微生物，但不必对每一种潜在病原体都有效。如果在手术过程中和手术后不久血液和组织中存在有效浓度，就可以预防感染。因此，抗菌素预防应在手术前开始：早开始是不必要的，而且有潜在危险，晚开始效果较差。麻醉诱导后单剂量预防就足够了。如果手术延迟或延长，如果使用半衰期短的抗菌药物，建议使用第二剂。术后给药是不必要的，也是有害的。头孢菌素被认为是首选药物，因为它们的过敏反应较少。从第一代头孢菌素开始，头孢唑林被广泛推荐并获得成功。从第二代头孢菌素开始，越来越多地推荐使用头孢呋辛、头孢曼铎和头孢西丁。它们的抗葡萄球菌活性稍弱，但对革兰氏阴性菌的活性较强。此外，头孢西丁对厌氧菌具有良好的抗氧化活性。第三代头孢菌素，如头孢噻肟、头孢哌酮、头孢曲松、头孢他啶或头孢替肟，一般不推荐用于手术预防。尽管有这些建议，但它们已被医学界所接受，今天在许多国家作为最常用的手术预防药物使用。尤其是头孢曲松，其销量远远超过其他任何预防药物。讨论了禁忌症、局限性、额外或其他药物和具体程序的实用建议，并介绍了几项前瞻性随机研究的结果。
Controlled clinical trials have shown that antimicrobial prophylaxis can lower the incidence of infection after certain operations, thus reducing morbidity, hospital stay, antibiotic usage and mortality due to sepsis. An effective prophylactic regimen should be directed against the most likely infecting organisms, but need not be active against every potential pathogen. Infection can be prevented when effective concentrations are present in the blood and the tissue during and shortly after the procedure. Therefore, antimicrobial prophylaxis should begin just before the operation: beginning earlier is unnecessary and potentially dangerous, beginning later is less effective. A single-dose prophylaxis after the induction of anesthesia is sufficient. If surgery is delayed or prolonged, a second dose is advisable if an antimicrobial drug with a short half-life is used. Postoperative administration is unnecessary and is harmful. Cephalosporins are considered to be the drug of choice, because they offer fewer allergic reactions. From the first generation cephalosporins, cefazolin has been widely recommended with success. From the second generation cephalosporins, cefuroxime, cefamandole and cefoxitin are increasingly recommended. Their antistaphylococcal activity is somewhat less strong but their activity against Gram-negative bacteria is stronger. In addition, cefoxitin has good activity against anaerobes. Third generation cephalosporins, such as cefotaxime, cefoperazone, ceftriaxone, ceftazidime or ceftizoxime are generally not recommended for surgical prophylaxis. Despite these recommendations, they have been accepted by the medical community and are today in use in many countries as the most common drugs in surgical prophylaxis. Ceftriaxone in particular, is far exceeding the sales of any other drug for prophylaxis.Contra-indications, limitations, additional or other drugs and practical recommendations for specific procedures are discussed and the results of several prospective randomized studies are presented.