Rational use of antibiotics in surgery

Widespread use of antibiotics has contributed to antibiotic resistance among common bacterial species. Appropriate use of antimicrobial agents is vitally important from a clinical perspective, and is essential if the usefulness of antibiotics is to be preserved and the further spread of resistance limited. A logical approach to managing the infected patient (choosing appropriate antimicrobial agents, giving them by the optimal route and for the correct duration) is essential. This contribution discusses the rationale behind good antimicrobial prescribing in the surgical patient which, in its simplest sense, is based on empirical or targeted therapy. However, the process of regular patient review, reducing the spectrum of cover as results become available, switching from intravenous to oral therapy as soon as is appropriate and clearly defined stop or review dates should be followed in all patients on antimicrobial agents. The use of antimicrobial agents for surgical prophylaxis is not discussed in this review.