Need and duration of antibiotic therapy in clean and clean contaminated operations.

OBJECTIVE To define the need and duration of prophylactic antibiotic administration in clean and clean contaminated surgery in the prevailing operating theatre environment in Karachi. SETTING Surgical Department of Hamdard University Hospital and three other private hospitals in Karachi. METHODS One hundred consecutive patients undergoing elective clean and clean contaminated surgery were recruited from October 2000 to October 2001. Patients were admitted either a day prior to surgery or on the day of surgery, depending on the nature of procedure. Prophylaxis was provided by single dose of antibiotic at induction. The rest of the pre-operative preparation was done in standard way. Patients were discharged home as dictated by the nature of the operation and social circumstances. Wounds were examined for Surgical Site Infection (SSI) on day 4 and day 11. Patients who had post-operative pyrexia or signs of SSI were given extended antibiotic treatment for 5 days or until resolution of infection. RESULTS Four out of 8 patients who developed SSI required extended antibiotic treatment. CONCLUSION Single dose prophylactic antibiotic therapy is satisfactory in our surgical environment. This practice would be efficient, cost effective and prevent the emergence of nosocomial infections in a developing country such as Pakistan with extremely limited health care resources.