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A Critical Analysis of the Literature

B. Joseph Guglielmo, PharmD; David C. Hohn, MD; Peter J. Koo, PharmD; Thomas K. Hunt, MD; Richard L. Sweet, MD; John E. Conte, Jr, MD

Arch Surg. 1983;118(8):943-955.

Abstract
• The use of prophylactic antibiotics in surgery is widespread and often inappropriate. The lack of well-designed clinical studies partially explains the present confusion regarding the subject. We reviewed the literature in English on antibiotic prophylaxis through June 1982. Antibiotic prophylaxis reduces the incidence of wound infection after colorectal surgery, vaginal hysterectomy, and laryngeal and oropharyngeal resection for carcinoma, and in high-risk patients undergoing gastroduodenal or biliary surgery. In clean operations such as cardiac surgery, vascular procedures, and orthopedic surgery with placement of prostheses, the high morbidity associated with an infection justifies the use of antibiotics even though the risk of infection is small. There are conflicting data on the usefulness of prophylaxis in abdominal hysterectomy, cesarean section, noncardiac thoracic procedures, and urologic surgery. The effectiveness of prophylaxis in neurosurgery cannot be evaluated at the present time.

(Arch Surg 1983;118:943-955)

Author Affiliations
From the School of Pharmacy, Division of Clinical Pharmacy (Drs Guglielmo and Koo), the Department of Surgery (Drs Hohn and Hunt), the Department of Obstetrics and Gynecology (Dr Sweet), and the Department of Medicine, Division of Infectious Diseases (Dr Conte), University of California, San Francisco.

Footnotes
Accepted for publication March 4, 1983.

Reprint requests to Division of Clinical Pharmacy, School of Pharmacy 926-S, University of California, San Francisco, San Francisco, CA 94143 (Dr Guglielmo).

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