The rational use of antibiotics means using the right medicine, in the right dose, for the right duration, and only when needed. Misuse and overuse of antibiotics are major causes of antimicrobial resistance (AMR), which makes infections harder to treat. Surgical prophylaxis is another area where antibiotics are used to prevent infections before and during surgery. Proper guidelines help improve patient safety and reduce unnecessary antibiotic use.
Principles of Rational Antibiotic Use
1. Confirm the Need for an Antibiotic
Antibiotics should be used only for bacterial infections. Many common illnesses—such as the common cold, flu, and most sore throats—are caused by viruses and do not need antibiotic therapy.
2. Identify the Causative Organism
Whenever possible, antibiotic choice should be based on culture and sensitivity testing. Knowing the organism helps select an effective and targeted drug instead of using broad-spectrum antibiotics unnecessarily.
3. Choose the Right Antibiotic
- Use narrow-spectrum antibiotics when the organism is known
- Reserve broad-spectrum drugs for severe infections or unknown organisms
- Follow local antibiograms and hospital antibiotic guidelines
4. Select the Correct Dose and Route
- Dose must achieve therapeutic concentration at the infection site
- Oral route is preferred for mild to moderate infections
- Intravenous (IV) route is needed for severe or hospital-acquired infections
5. Use the Appropriate Duration of Therapy
Shorter courses (3–5 days) are now recommended for many infections to avoid resistance and side effects. Longer courses are used only for specific conditions such as tuberculosis, endocarditis, and osteomyelitis.
6. Avoid Unnecessary Combination Therapy
Combining antibiotics is required only in special conditions—like tuberculosis, mixed infections, or severe sepsis. Unnecessary combinations increase toxicity and resistance.
7. Monitor Patient Response
Clinical improvement should guide therapy. If no improvement is seen, reassess the diagnosis, drug choice, and laboratory data.
Common Mistakes in Antibiotic Use
- Starting antibiotics without confirming infection
- Using leftover antibiotics or self-medication
- Stopping antibiotics too early
- Prescribing unnecessarily high doses
- Using broad-spectrum drugs for minor infections
Antibiotic Stewardship
Antibiotic stewardship programs in hospitals aim to optimize antibiotic use. They help:
- Reduce antimicrobial resistance
- Improve treatment outcomes
- Reduce hospital costs
- Lower adverse drug events
Surgical Prophylaxis
Surgical prophylaxis involves giving antibiotics before surgery to prevent surgical site infections (SSIs). The key goal is prevention—not treatment—of infection.
1. Timing of Prophylaxis
- Give the first dose within 60 minutes before incision
- For drugs like vancomycin or fluoroquinolones, start 60–120 minutes before surgery
2. Choice of Antibiotic
The antibiotic must cover the most likely organisms involved in surgical wound contamination.
- Cefazolin is the most common choice for clean surgeries
- Metronidazole + ceftriaxone/cefazolin is used for surgeries involving the gastrointestinal tract
- Vancomycin is used if MRSA risk is high
3. Duration of Prophylaxis
- Single dose is usually enough
- Do not continue prophylaxis for more than 24 hours
- Prolonged use increases resistance without added benefit
When Surgical Prophylaxis Is Recommended
- Clean-contaminated surgeries (gastrointestinal, respiratory, genitourinary)
- Prosthetic implant surgeries
- Cesarean section
- Major orthopedic procedures
Clean surgeries like simple hernia repair may not require prophylaxis unless foreign materials are implanted.
Preventing Antimicrobial Resistance
- Use antibiotics only when essential
- Follow standard treatment guidelines
- Promote vaccination to prevent infections
- Improve hygiene and infection control practices
- Avoid unnecessary use of broad-spectrum agents
Detailed Notes:
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