We endorse the viewpoint of Warters et al.  1in their letter “Preoperative Antibiotic Prophylaxis: The Role of the Anesthesiologist.” Various guidelines have been proposed recommending prophylaxis for at-risk patients undergoing at-risk procedures. In spite of the guidelines for antibiotic prophylaxis formulated in the last few years, their prescription pattern still remains inappropriate.2The seriousness of the potential infection has led the anesthesiologist to play an important role. Adhering to strict antiseptic technique in patient preparation, during and after surgery, still remains the best prophylaxis against postoperative infections. Surgical site infections increase total hospital expenses and extend the duration of hospital stay. Antibiotic prophylaxis has been demonstrated to be of greater benefit than risk in procedures with higher infection rates. Various studies have validated the fact that the antimicrobial prophylaxis is not indicated for procedures with low infection rate because the expected benefit of antimicrobial treatment is less than the risk of adverse medication reaction.3,4 

Because the data are limited and the problem is complex, decisions must be tailored to the individual patient and the surgical procedure. Anesthesiologists are increasingly involved in perioperative antibiotic administration and postoperative infection control. In a study by Silver et al. ,5it was concluded that by delegating implementation of antibiotic prophylaxis to the anesthesiology team, the incidence of postoperative wound infection may decrease. With this responsibility comes accountability. Antibiotic sensitivity test results before administration should be known because it is of paramount importance to avoid untoward adverse (anaphylactic/anaphylactoid) reactions. To minimize such events, a scratch or puncture test may be preformed before more definitive intradermal tests.6Appropriate skin testing concentrations of medications commonly used in anesthetic practice have been published.7Patients with positive skin test results to any penicillin reagent should probably not receive cephalosporin antibiotics unless substitutes are clearly less efficacious.

Unfortunately, the postgraduate teaching in anesthesiology does not impart extensive training in antibiotic pharmacology. Most of the training programs, especially in developing countries such as ours, have only four to five lectures dealing with antibiotics, their perioperative role, and their potential interaction with the anesthetic drugs. Most of the curriculums and continued medical education programs skip this vital education. Hence, it should be made pertinent that all anesthesiologists are regularly updated regarding the pros and cons of the usual antibiotics used perioperatively.

* Dayanand Medical College and Hospital, Ludhiana, Punjab, India. anuragtiv@rediffmail.com

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Tocchi A, Lepre L, Costa G, Liotta G, Mazzoni G, Maggiolili F: The need for antibiotic prophylaxis in elective cholecystectomy: A prospective randomized study. Arch Surg 2000; 135:67–70
Silver A, Eichorn A, Karl J, Pickett G, Barie P, Pryor V, Dearie MB: Timeliness and use of antibiotic prophylaxis in selected inpatient surgical procedures. The Antibiotic Prophylaxis Study Group. Am J Surg 1996; 171:548–52
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