For example Patient came with Post trauma sepsis and doctor ordered Inj. Meropenem . Now If in this case doctors need emergency Craniotomy. now how would you suggest surgical prophylaxis in terms of Drug, dose and duration??
The aim of perioperative antibiotics is prophylaxis of infection caused by surgical trauma. If you are performing craniotomy, you need antibiotics against skin pathogens (e.g staphyloccocus), by urogenital surgery against typical uro bacteria, (e.g for E.coli Ciprofloxacine).
If you have other source of infection and antibiotic therapy you need to check, if your antibiotic therapy is effective for the bacteria on your surgical site.
Secondly, the timing of antibiotics before surgery is crucial. Before your incision, you need effective dosis of antbiotics in your surgical site. 30-60 Minutes before incision is the recommendation.
In Your case I would suggest:
mostly the therapy plan of meropenem doesn´t match with time of surgery, you do not have guarantee for the peak level of antibioticasin your surgical site. I would suggest the additional dose of cephalosporine (eg. Cephazoline) 2g (in 10ml Saline). You give 1 ml testdosis the check allegic reaction, than the rest. The timing 30-60 before incision.
If the surgery takes longer than 4 hours, you give the second dose.
at the day of surgery you give one dosis cephalosporins at night after surgery and the last one the next day. You have very good effectivness of cephalosporines against staphylococcus.
Thank you Boris Vidinsky sir.. for valuable feedback.
But sir don't you think patient was already on broad spectrum antibiotic. than cephalosporin will be rational??
Yes, meronem is very broad spectrum, with very good effect against gramnegat and little bit less against gramposit bacteria. with the additional intraoperative shots of cephalosporines, you additonaly add a very effective antibiotic against grampositive bacteria, your main bacteria on your skin.
the additional dosis of cephalosporine on the next day after surgery is usuall in our clinic, because of heart lung machine and bigger distribution volumina for drugs.
Generally, this problem is very controversial, an I know you have different clinics with different approaches.
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