When to start antiviral (antiviral) prophylaxis in post-operative patients?

Timing of Antibiotic Prophylaxis in Surgical Patients

Antibiotic prophylaxis should be administered within 60 minutes before surgical incision (120 minutes for fluoroquinolones and vancomycin) and discontinued within 24 hours after surgery completion in most cases. 1, 2

Preoperative Timing

Optimal Administration Window

• Administer prophylactic antibiotics within 60 minutes before surgical incision 1
• For fluoroquinolones and vancomycin, administer within 120 minutes before incision 2
• The National Surgical Infection Prevention Project specifically recommends beginning antibiotic infusion within 60 minutes before incision 1
• Complete antibiotic administration before tourniquet inflation if applicable 1

Rationale

• Optimal antibiotic levels must exceed the minimum inhibitory concentration in tissue from incision through wound closure 1
• Proper timing ensures adequate tissue concentrations during the entire procedure 2
• Studies show significantly higher infection rates when antibiotics are administered outside this window 3

Postoperative Duration

Standard Recommendation

• Discontinue prophylactic antibiotics within 24 hours after surgery completion 1, 2
• For clean or clean-contaminated procedures, all perioperative antimicrobials should be discontinued within 24 hours 1
• Single-dose prophylaxis is sufficient for most procedures 2, 4

Special Considerations

• In transplant surgery other than renal transplant, extension to 48-72 hours may be considered depending on the type of transplant 1
• For open fractures, antibiotics should be continued for 3 days (type I and II fractures) or 5 days (type III) 1
• For prosthetic device implantation, consider extended coverage up to 24 hours 2

Intraoperative Redosing

• For procedures lasting longer than two half-lives of the initial antibiotic dose, additional intraoperative doses are required 2
• Redose when excessive blood loss (>1.5L) occurs during the procedure 2
• Dosing should be adjusted based on patient's weight and redosed at intervals of every two half-lives 1

Common Errors to Avoid

• Extending prophylaxis beyond 24 hours does not reduce infection rates but increases antimicrobial resistance risk 2, 5
• Failure to administer antibiotics within the optimal pre-incision window significantly reduces efficacy 2, 3
• Using inappropriate antibiotics can lead to inadequate coverage 2
• Failure to redose during lengthy procedures 2

Special Patient Populations

Patients with Multidrug-Resistant Gram-Negative Bacteria

• Even in patients colonized with multidrug-resistant gram-negative bacteria, prophylaxis should still be discontinued within 24 hours after surgery 1
• Consider targeted prophylaxis based on preoperative culture results 2

Patients with Indwelling Catheters

• For short-term catheterization (<48-72 hours): No prophylaxis needed at removal 2
• For prolonged catheterization: Consider culture-directed therapy or empiric treatment 2

Despite historical practices of continuing antibiotics throughout hospitalization 5, current high-quality evidence strongly supports limiting prophylaxis to 24 hours or less in most cases 1, 4. The evidence consistently shows that extending prophylaxis beyond 24 hours does not reduce infection rates but increases the risk of antimicrobial resistance, adverse effects, and healthcare costs.