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Richard Chudacoff, MD, FACOG
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of Braun, R.
Daniel
Sent: Thursday, June 20, 2002 4:27 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: WINDOW TIME FRAME FOR PRE-OP ANTIBIOTICS
That is for Major Gynecologic procedures not for Cesarean sections.
-----Original Message-----
From: ainsron@sbcglobal.net [mailto:ainsron@sbcglobal.net]
Sent: Thursday, June 20, 2002 3:42 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: WINDOW TIME FRAME FOR PRE-OP ANTIBIOTICS
Here's the recommendations from ACOG:
CLINICAL MANAGEMENT GUIDELINES FOR OBSTETRICIAN-GYNECOLOGISTS NUMBER 23,
JANUARY 2001 (Replaces Technical Bulletin Number 237, June 1997)
" State-of-the-art aseptic technique has been associated with a dramatic
decrease in operative-site infections, but bacterial contamination of
the operative site is inevitable. The in vivo interaction between the
inoculated bacteria and prophylactically administered antibiotic is one
of the most important determinants of the state of the surgical site.
Systemic antibiotic prophylaxis is based on the belief that antibiotics
in the host tissues can augment natural immune-defense mechanisms and
help to kill bacteria that are inoculated into the wound. Only a narrow
window of antimicrobial efficacy is available, requiring the
administration of antibiotics either shortly before or at the time of
bacterial inoculation (eg, when the incision is made, viscus entered, or
pedicles clamped). A delay of only 3-4 hours can result in ineffective
prophylaxis (4). The induction of anesthesia represents a convenient
time for initiating antibiotic prophylaxis in major gynecologic
procedures. Current data indicate that for lengthy procedures,
additional, intraoperative doses of an antibiotic, given at intervals of
one or two times the half-life of the drug, maintain adequate levels
throughout the operation (5). A second dose of the prophylactic
antibiotic also may be appropriate in surgical cases with an increased
blood loss (>1,500 mL). Neither subsequent doses nor treatment for
several days before a procedure is indicated for prophylaxis. The use
of prophylaxis implies that the patient is presumed to be free of
infection at the time of the procedure. During a procedure when a
patient is found to be at greater risk for disease, use of therapeutic
antibiotics should be considered."
>Can you tell me the time frame established by the APIC group that
pre-op
>antibiotics should be given? We have a gyn questioning. Thanks
>
>Susan Wescoat RN
