Perioperative antibiotic prophylaxis in adults - Sistema Nazionale ...

arthroplasty 183 found no difference in wound infection rates after administration of 1or 3 doses of cefuroxim. The study found that infection of the joint was less frequentin the group who received three doses (0.45% compared with 0.83%), but thedifference was not statistically significant (OR 0.54;95% CI 0.20-1.48).A recent observational study of patients undergoing cemented hip arthroplasty foundfewer repeat operations for the removal or replacement of the prosthesis whenprophylaxis was continued for 24 hours and antibiotic was added to the cement 190 .Three recent studies, including one of patients undergoing appendicectomy (for nonperforatedappendix), one of patients undergoing surgery for gastric carcinoma and athird of patients undergoing gynaecological surgery, confirm that the administrationof a single perioperative dose of antibiotic has the same effect in preventing SSI asrepeated doses 191-193 .There is no evidence to show that continuing antibiotic prophylaxis reducespostoperative infections when drainage is used.RecommendationsI/A Antibiotic prophylaxis should be limited to the perioperative period and shouldbe administered immediately before the operation begins.There is no evidence to support the increased effectiveness of prolonged prophylaxis;in most cases a single dose of antibiotic is sufficient (administered within 30-60minutes before the skin is incised).A decision to continue prophylaxis beyond the first 24 postoperative hours is notjustified.# Prolonging prophylaxis for the first 24 postoperative hours may be justified inspecific clinical situations with a high risk of postoperative infections.Every decision to prolong prophylaxis beyond the duration indicated in localguidelines should be justified in the case notes.