Principles and Guidelines of Antimicrobial Therapy in Gastroenterological Surgery

Naoki Aikawa

Department of Emergency and Critical Care Medicine, School of Medicine, Keio University

Appropriate antimicrobial therapy together with aseptic surgical procedures and necessary surgical drainage is an important element in controlling infections seen in gastroenterological surgery. For the treatment of primary surgical infections such as cholecystitis and peritonitis, empiric chemotherapy is performed by slecting the most appropriate antimicrobial agent through four steps. In those steps, factors including pathogens implicated in the infection, the pathogen's antimicrobial susceptibility, prevalence of resistant organisms, the agent's pharmacokinetics, the patient's host-defense status, and cost of the treatment are considered. With respect to prophylactic antimicrobial therapy for patients undergoing gastroenterological surgery, an antimicrobial agent is chosen and the length of the antimicrobial coverage is decided by considering the organ's normal flora, and the balance between the degree of contamination and the patient's host-defense status. The prophylactic therapy must be commenced immediately prior to the surgery and continued for not more than three postoperative days. For the treatment of postoperative infections, prompt empiric chemotherapy is crucial together with surgical drainage if necessary. To eradicate methicillin-resistant Staphylococcus aureus, vancomycin is a first-choice agent. However, abuse of vancomycin must be avoided to prevent development of a resistant stain.

Key words
empiric chemotherapy, antimicrobial prophylaxis, surgical site infection

Reprint requests
Naoki Aikawa Department of Emergency and Ctitical Care Medicine, School of Medicine, Keio University
35 Shinanomachi, Shinjuku-ku, Tokyo 160 JAPAN

Accepted
October 9, 1996

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