Perioperative antibiotic prophylaxis in adults - Sistema Nazionale ...

I/A Antibiotic prophylaxis should be limited to the perioperative period and shouldbe administered immediately before the start of surgery. There is no evidence thatprolonged prophylaxis is more effective; in most cases a single dose of antibiotic(administered 30-60 minutes before the skin is incised) is sufficient. There is nojustification for continuing prophylaxis beyond the first 24 postoperative hours.# For longer operations most guidelines suggest the administration of anintraoperative dose when the operation has been in progress for double the half-life ofthe drug administered, although no definitive data are available.IV/B The administration of an additional intraoperative dose of antibiotic (to begiven after fluid replacement) is indicated for adults if blood loss during surgeryexceeds 1,500 ml or if blood dilution has exceeded 15 ml/kg.# Prolongation of prophylaxis to the first 24 postoperative hours may be justified inspecific clinical situations when the risk index for postoperative infections is high.Any decision to prolong prophylaxis beyond the time indicated in the local guidelineshould be justified in the case records.Local implementation of the guideline# The implementation strategies most widely supported by evidence of efficacy are:agreement on the protocol regarding prophylaxis between surgeons, anaesthetists andall operating theatre personnel; attention to organisational problems; the specificassignment of responsibility for application of the protocol; the availability ofpersonalised kits from the pharmacy.VI/A Auditing the appropriateness of perioperative antibiotic prophylaxis isfacilitated if the minimum data set is registered in the case records and treatmentchart.