Duration for Antibiotic Prophylaxis In Surgery

• For many types of commonly performed surgery there is consistent evidence that a single dose of antimicrobial with a long enough half-life to achieve activity throughout the operation is adequate.
• There is evidence from several studies of antibiotic prophylaxis during surgery that longer dosage duration has no increased benefit over a short course.
• According to Clinical Practice Guidelines for antimicrobial prophylaxis in Surgery (2013), a shortened post-operative course of antimicrobials involving a single dose or continuation for less than 24 hours are provided for certain conditions.

A second dose may be required in the following situations:

- delay in start of surgery

- in prolonged operations when the time is more than half of the usual dosing interval of the antibiotic

Condition	Duration	Evidence
Open reduction and internal fixation of compound mandibular fractures	The duration of prophylactic antibiotics should not be more than 24 hours	Prophylaxis is recommended for all patients with an increased risk of surgical wound infection(NAG, 2014)
Complex septorhinoplasty (including grafts)		-
Head and neck surgery (contaminated/clean contaminated)		-
Open heart surgery	The duration of prophylactic antibiotics should not be more than 48 hours	An additional intraoperative dosage of antibiotic is recommended for cardiac surgery longer than four hours when using an antibiotic with pharmacokinetics equivalent to cefazolin. From NAG, Antibiotic prophylaxis of 48hours duration is clinically effective in minimizing infectious complications in cardiac surgery. Postoperative prophylactic antibiotics are given for 48hours or less
Arthroplasty	The duration of prophylactic antibiotics should not be more than 24 hours	In arthroplasty, there is evidence from a very large observational cohort that 24 hours of antimicrobial prophylaxis is associated with lower rates of re-operation than a single dose. Up to 24 hours of antibiotic prophylaxis should be considered for arthroplasty

* Under Obstetrics & Gynaecology, for Repair of Perineal Tear e.g. third or fourth degree tears, antibiotics are continued for 5-7days. (NAG,2014)

References:

http://www.ajhp.org/content/70/3/195

http://www.sign.ac.uk/pdf/sign104.pdf

National Antibiotic Guideline, 2014

http://cid.oxfordjournals.org/content/33/Supplement_2/S78.full