For the prevention of surgical wound infection, the antibiotic must be present in the tissues at the time of incision in sufficient concentrations to kill the bacteria most likely to contaminate the wound. It should not be of a broader spectrum than necessary. Antibiotics administered after surgery confer no additional benefit and pose the risk of the induction of bacterial resistance or adverse side-effects ( Classen. etai 1992). A short course (24 h) of a bactericidal antibiotic should be started at induction of anesthesia. For operations where a site with normal flora is entered, a second-generation cephalosporin either with or without metronidazole is a common choice. In cardiac surgery, flucloxacillin plus an aminoglycoside can be used, although cephalosporins are effective despite the resistance of most coagulase-negative staphylococci. The glycopeptides are active against these organisms, but vancomycin can cause hypotension during surgery and teicoplanin may not achieve sufficiently high tissue levels after a single preoperative dose.

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