Prophylactic antibiotics in chest surgery

Antimicrobial prophylaxis in cardiothoracic surgery can decrease the risk of postoperative infections, in particular the life threatening ones. The benefit must be weighed against the risk of toxic and allergic reactions, the selection of resistant strains and superinfection. The cost of the chosen antibiotic regiment must also be considered. In general antimicrobial prophylaxis is recommended only for patients who undergo procedures with high risk of infection, those involving implantation of prosthetic materials and others in whom infection could be disastrous. An effective regimen should be directed against the most likely infecting organisms but not every potential pathogen. Cefalosporines are the first choice world-wide, as antimicrobial prophylaxis. Single-shot regiment is considered sufficient for the majority of patients undergoing uncomplicated or low risk operations. Antimicrobial prophylaxis should not continued more than 24 hours, because of selection of micro-organisms and emergence of drug resistance. Administration of prophylaxis must be performed at the induction of anaesthesia. in ''dirty'' surgery, administration of antibiotics must be considered treatment rather than prophylaxis. Surgeons have to remember that antibiotic administration can not prevent infections due to incorrect preventive measures, especially during the operative procedure.