Role of minimal antibiotic therapy and routine long term post-operative therapy in elective surgery: an evaluation

Abhijeet S. Divan, Mahendra K. Dhuware, Manoj K. Bharti, Nitesh K. Dubey


Background: Antibacterial drugs are powerful agents to prevent infections but excess use of antibiotics led to increase of resistance towards the antibiotics used and thus has risen the expense in medical support.

Methods: A total of 250 patients were included in the study. The patients were divided randomly into 2 groups, each containing 125 patients. Group I patients received. Three dosage of injectable ceftriaxone 1 gram intravenous peri-operatively, first dose twelve hour before surgery and second dose half hour before surgical incision and third dose twelve hours after surgery. Group II patients were given injectable ceftriaxone 1 gram intravenous peri-operatively, first dose twelve hour before surgery and second dose half hour before surgical incision and then followed by injection (conventional dose) ceftriaxone 1 gram/day I.V twice daily for the first 5-7 days post-operatively. Using Southampton wound grading system. The wound was inspected on the 3rd, 5th and 7th postoperative day days post operatively.

Results: In group I, 15 (12%) cases had grade 2 SSI and in group II, 11 (8.8%) cases had grade 2 SSI. There was no statistical significance: p value is 0.83 and c2 0.048.

Conclusions: A minimal dose antibiotic prophylaxis is equally efficient and has added advantage of reducing the duration of hospital stay and cost of medicines for the patients. Hence minimal dose antibiotic is better than a routine long term antibiotics therapy.


Antibiotic prophylaxis, Surgical site infection, Southampton wound grading, Cost effective

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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70:195-283.

WHO-Surveillance of Antimicrobial resistance. Available at: surveillance/en. Accessed on 24 January 2021.

Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK et al. Clinical practice guideline for antimicrobial prophylaxis in surgery. Am J Health-System Pharm. 2013;70;195-283.

Aggarwal KK, Chandra J, Prakash A, Kaur R, Saxena S, Garg A, et al. National Treatment Guidelines for Antimicrobial use in Infectious Diseases. National Centre For Disease Control, MOHFW, Government of India. 2016.

Howells CHL, Young HB. A study of completely undressed surgical wound. Br J Surg. 1966;53(5):436-9.

Levua HL, Khambholja JR, Nayak KK, Shah RC. Role of antibiotics in clean surgeries: Prophylaxis v/s conventional. Gujrat Med J. 2014;69:96-8.

Chambers HF. Beta lactam antibiotics and other antibiotics of cell wall synthesis. In: Katzung BG, editor. Basic of Clinical Pharmacology. 8th Ed. New York: Lange Medical Books, McGraw-Hill. 2001;762.

Naz MZ. A comparative study between a single dose cephradine as a prophylaxis versus conventional dose antibiotic in major gynecological procedure in SSMC and MH. Dissertation for FCPS, BCPS, Mohakhali Dhaka. 2001.

Burdon DW. Principles of antimicrobials prophylaxis. World J Surg. 1982;6(3):262-7.

Ronald AR. Antimicrobial prophylaxis in surgery. Surgery. 1983;93(1):172-3.

Antimicrobial prophylaxis for surgery. Med Lett Drugs Ther. 1985;27(703):105-8.

Larsen RA, Evans RS, Burke JP, Pestotnik SL, Gardner RM, Classen DC. Improved perioperative antibiotic use and reduced surgical wound infections though use of computer decision analysis. Infect Control Hosp Epidemiol. 1989;10(7):316-20.

Tariq NA. The antibiotic prophylaxis an effective safe and economic modality, a comparative study biomedical. Med Channel. 1994;10:28-30.

Scheinfeld N, Struach S, Ross B. Antibiotic prophylaxis guideline awareness and antibiotic prophylaxis use among New York State dermatologic surgeons. Dermatol Surg. 2002;28:841-4.

Tiwari S, Chauhan M, Shahapurkar VV, Akhtar MJ, Grover A, Prashad S, Nerkar E. “Importance of Southampton Wound (Grading System in Surgical Site Infection”. J Evol Med Dent Sci. 2014;3(20):5491-5.

Scott JD, Forrest A, Feuerstein S, Fitzpatrick P, Schentag JJ. Factors associated with postoperative infection. Infect Control Hosp Epidemiol. 2001;22:347-51.

Londahl M, Fagher K, Katzman P. What is the role of hyperbaric oxygen in the management of diabetic foot disease? Curr Diabet Rep. 2011;11(4):285-93.

Sindgikar V. Effect of serum albumin in wound healing and its related complications in surgical patients. Al Ameen J Med Sci. 2017;10(2).

Korol E, Johnston K, Waser N. A systematic review of risk factors associated with surgical site infections among surgical patients. PLoS One. 2013;8:e83743.

Khichy S, Singh B. To Compare the Effectiveness of Short-term Three Dose Perioperative Antibiotic Coverage during Decisive Period with Conventional Prolonged Postoperative Antibiotic usage in Clean Elective Surgical Cases: An Indian Perspective. Niger J Surg. 2017;23(2):92-7.

Konidala MVSS, Gopalam PR Kandati J. A study on comparison of short term three dose antibiotic prophylaxis with conventional prolonged post-operative antibiotic coverage in development of surgical site infection. Int Surgery J. 2018;5(6):2114-8.