Guidelines for rational use of antibiotics
Resistance to anti-microbial is common in hospitals and increasingly in the community knowledge of a precious adverse drug reaction may prevent the inappropriate administration of an anti-microbial drug to which the patient is allergic, restrict prophylactic anti-microbial therapy to situations in which it has been shown to be effective or where the consequences of infections are disastrous if a non-infective diagnosis is confirmed, early cessation of anti-microbial is warranted, it is important to review the empirical regimen when culture results have identified the organism present and their susceptibility to anti-microbial drugs.it is important to restrict topical anti-microbial therapy to few proven indications. To minimize selection of antibiotic resistance it is important to limit duration of therapy. Prophylaxis is the use of antibiotics to prevent infection at surgical site. One third to one half of antibiotic use in hospital practice is for surgical prophylaxis studies have shown levels of inappropriate use ranging from 30 to 90%. Prophylaxis should be considered when there is a significant, risk of infection, where postoperative infection, routine use of vancomycin prophylaxis should be discouraged, to prevent selection pressure for vancomycin-resistant enterococci (VRE) and vancomycin-intermediate MRSA(VISA), the route of administration, timing and duration of prophylactic antibiotics should be chosen to achieve effective plasma and tissue levels of the drugs during and shortly after the surgical procedure, when bacterial contaminations is maximal. IV antibiotic should be given as soon as the patient is stabilized after induction of anesthesia, the critical period for successful prophylaxis is the 4 hours following implantation of organisms into a wound. A second dose may be necessary under special circumstances.
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