Excerpt from Antibiotics, Prophylactic Use in Head and Neck Surgery

Synonyms, Key Words, and Related Terms: prophylactic antibiotics, prophylaxis, antibiotic, antimicrobial

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Prophylaxis with antimicrobials has decreased the high incidence of wound infection after head and neck operations that involve incisions through oral or pharyngeal mucosa. Prophylactic administration of antibiotics can decrease postoperative morbidity, shorten hospitalization, and reduce overall costs attributable to infections.

Principles of prophylaxis include providing effective levels of antibiotics at the time of wound exposure and effective prophylactic regimens. The regimen should be directed against the most likely infecting organisms. Only those organisms commonly cited as pathogens need to be eradicated.

Many antimicrobials require a single dose given within 30 minutes of skin incision to provide adequate tissue concentration throughout the operation. Additional doses during the procedure are advisable if surgery is prolonged (ie, > 4 h), major blood loss occurs, or an antimicrobial with a short half-life is used.

The aim of prophylaxis is to augment host defense mechanisms at the time of bacterial invasion, thereby decreasing the size of the inoculum. Prophylaxis is an attempt to attack organisms before they have a chance to induce infection. Previous surgery (ie, scarring) and radiation injury decrease host defenses. Likewise, certain medical conditions, such as diabetes mellitus or HIV, predispose the patient to infection because of diminished host response.

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