Guidelines for the use of prophylactic antibiotics in surgery in Taiwan.

Two converging factors highlight the need to optimize the use of prophylactic antibiotics in surgery. First, there is an increasing global emergence of antimicrobial resistance. The problem is complex and multi-faceted, but the selective force of overuse of antibiotics plays an important role. The second factor is the transition to the era of managed care requiring both cost containment and quality assurance. Appropriate use of antimicrobial agents for surgical prophylaxis has been shown to reduce the incidence of postoperative infection for a variety of surgical procedures. Several guidelines for prophylactic use of antimicrobial agents are available to guide the indications, timing of administration, choice of drug and duration of prophylaxis. Unfortunately, poor compliance with standard guidelines has been reported. The standard guidelines recommend that prophylaxis is indicated only for clean-contaminated and specific clean surgical procedures where the benefits in preventing a rare infection exceed the risks and costs of prophylaxis. It is essential that antibiotic prophylaxis be initiated in close proximity to the time of the surgical procedure, in order to achieve effective tissue concentrations at the time of incision and throughout the operation. The major exception is cesarean section, in which the first dose of prophylaxis should be delayed until the umbilical cord is clamped to avoid placental transfer of the antibiotic to the fetus. Selection of an antibiotic should consider spectrum of activity and costeffectiveness. A single dose of antibiotic before the Guidelines for the use of prophylactic antibiotics in surgery in Taiwan