Surgical Prophylaxis: Treatment, Procedure, Cost and Side Effects

Surgical prophylaxis is associated with the prevention of infections at the surgical site with the use of antibiotics. It has become the standard of treatment and care for a contaminated or clean-contaminated surgery, and also for a surgery which involves insertion of artificial devices. The antibiotics only cover the likely pathogens which should be given at the correct time. This usually is given while on anesthesia for most parenteral antibiotics. A single dose is usually enough in case the surgical duration is 4 hours or less. Inappropriate usage may lead to high cost as well as emergence of resistant bacteria. In case of prophylaxis, the choice of antibiotic depends on multiple factors, such as antibiotic and penicillin allergy. Most importantly, it is necessary that the antibiotic is active against the bacteria which will most likely lead to an infection. Most postoperative infections arise due to the bacterial flora of the patients. Prophylaxis generally does not need to cover all the bacterial species in a patient’s flora, the reason being that some species are low in number and not particularly pathogenic. It is very important than an antibiotic with the narrowest antibacterial spectrum is used in order to reduce the risk of multi-resistant pathogens emerging or the patient developing serious sepsis. Oral fluconazole is the most common surgical prophylaxis medication.

Early diagnosis along with rapid appropriate treatment is considered the cornerstone of successfully managing the reduction of mortality rate in association with surgical infections. Prophylaxis treatment includes oral fluconazole as the superior or effective as compared to topical therapy for post surgery infections or the prevention of it. Oral therapy is considered better tolerated and more convenient than topical therapy. In addition, oral therapy is more efficacious than topical regimens in treating infections on the surgical site. Oral fluconazole (100 mg/day) is considered the best drug to treat this condition.

The usage of topical agents for the treatment of surgical infections diminishes systematic drug exposure, lowers the risk of drug-drug amalgamation, reduces the likelihood that antifungal resistance may develop, and systemizes adverse events. Multiple daily dosing and unfavourable taste in case of nystatin and clotrimazole leads to reduced endurance of topical therapy. An alternative to fluconazole is miconazole in mucoadhesive buccal tablets (50 mg/day) or clotrimazole troches 5 times daily may be used for the treatment of surgical infections. According to a multicenter, randomized study, these regimens were equivalent to fluconazole. Pastilles (4 times daily) or nystatin suspension remains till date as an additional alternative. An effective treatment for a surgical infection is systematic antifungals. A 14-21 day course of either oral intraconazole, intravenous or oral fluconazole solution is considered highly effective. Metronidazole is usually given 2-4 hours before the surgical process to prevent infection.

The eligibility criteria depends on the CD4 count. If the CD4 count is 350 cells or lower, the person is eligible for the treatment. The treatment is started as soon as the patient starts showing signs related to the disease.

In case of co-existing conditions patients are excluded. These include evidence of chronic or acute infection. Severe or moderate liver disease is also a criteria of non-eligibility. History of intolerance or allergy to azoles or imidazoles excludes you from receiving the treatment.

Side effects of the treatment include vomiting, nausea, abdominal pain, transaminase elevations, diarrhea, and hypertensive reactions like pruritus and rash.

In case of patients with a certain fungal infection, retaliation to antifungal therapy is rapid; symptoms usually improve in 48 to 72 hrs. Liver functions, especially in patients with hepatic comorbidities, must be monitored periodically in case azole therapy is carried out for more than 21 days. In renal failure, no dose adjustments are required. The post treatment guidelines are recommendations by doctors to carry out proper management by preventing and controlling the outbreaks. Hospital based infection control programs are there to help lessen the chances of relapse. Antibiotic stewardship is the most recommended method to reduce the risk factors. Patients must be monitored for symptoms of carbolic state or malnutrition. If indicated, parenteral or eternal electrolytes, lipids, carbohydrates, proteins and vitamins, and amino acids should be supplemented. A proper diet chart must be made.

It usually takes maximum 5 months to recover.

The price of treatment ranges between Rs. 1,000 to Rs. 10,000.

The results of the treatment is not permanent, hence fluconazole is used as a suppressive therapy in such cases. Relapse rate in patients with fungal infection or azole-refractory fungal manifestation is usually quite high.

The alternative treatment methods for an infection on the surgical site, is the intake of garlic, food items made from coconut oil, food items made from oregano oil, yogurt and apple cider vinegar.