Utilization of antimicrobial prophylaxis to prevent infection.
Antimicrobial prophylaxis may be primary, in the prevention of an initial infection, or secondary, preventing their recurrence or reactivation of infection, or it may be for preventing infection by eliminating a colonizing organism.
Primary prophylaxis refers to the prevention of an initial infection.
Secondary prophylaxis refers to the prevention of recurrence or reactivation of a preexisting infection.
Eradication refers to the elimination of a colonized organism to prevent the development of an infection.
Recommendations for the use of antimicrobial prophylaxis are graded according to the strength of evidence available;
Level I -evidence from large, well-conducted, randomized, controlled clinical trials or a meta-analysis.
Level II -evidence from small, well-conducted, randomized, controlled clinical trials,
Level III -evidence from well-conducted cohort studies,
Level IV -evidence from well-conducted case-control studies.
Level V -evidence from uncontrolled studies that were not well conducted.
Level VI -conflicting evidence that tends to favor the recommendation.
Level VII -expert opinion or data extrapolated from evidence for general principles and other procedures.
Recommendations are categorized according to the strength of evidence that supports the use or nonuse of antimicrobial prophylaxis as category A (levels I–III), category B (levels IV–VI), or category C (level VII).
Primary prevention of rheumatic fever with pharyngitis caused by group A beta hemolytic streptococci involves antibiotic treatment with penicillin or an alternative antibiotic.
Secondary antibiotic prophylaxis of rheumatic fever includes oral penicillin, oral sulfa drugs, intramuscular penicillin and alternative agents of erythromycin, erythromycin or azithromycin.
The duration of secondary antibiotic prophylaxis for rheumatic fever depends on the individual patient, taking into account the patient’s risk factors for recurrent disease, and the presence of carditis with or without underlying valvular disease.
The optimal time for administration of preoperative doses is within 60 minutes before surgical incision, however such drugsvas fluoroquinolones and vancomycin, require administration over one to two hours andvadministration of these agents should begin within 120 minutes before surgery.
Antibiotic prophylaxis for rheumatic fever should be considered for at least 10 years or until age 40 in patients with carditis with persistent valve disease.
Antibiotic prophylaxis for rheumatic fever should be continued in patients after prosthetic valve replacement surgery.
Antibiotic suppression for the prevention of rheumatic fever is not adequate management for ineffective endocarditis prophylaxis before dental procedures.
For patients with recurrent cellulitis from beta streptococcal disease secondary to lymphedema or venous insufficiency should be prophylactically treated if they ask greens more than 2-3 episodes per year: recommended this oral penicillin V or 1.2 million units and intramuscular benzathine penicillin.
In patients with recurrent pyogenic skin infections secondary to Staphylococcus aureus should have cleaning environmental surfaces, treatment of nasal colonized patients with mupirocin 4-5 days with or without topical body decolonization with a skin anti-septic solution such as 4% chlorhexidine.
Daily chlorhexidine bathing of patients in ICUs can reduce MRSA acquisition, decrease the concentration of bacteria on the body surface, and bloodstream infection from all pathogens.
Decolonization for staph aureus carriers involves a regimen of intranasal mupirocin and chlorhexidine bathing.
Antimicrobial prophylaxis for Neisseria meningitidis should be offered to close contacts of sporadic cases of meningitis: close contacts should be offered meningococcal vaccination if the outbreak strain is contained in the currently available meningococcal tetravalent conjugated vaccine, and antibiotic management with rifampin, ciprofloxacin or ceftriaxone.
Penicillin prophylaxis recommended in children during the first few years after splenectomy to prevent Streptococcus pneumoniae sepsis.
Haemophilus influenzae type B, menningococcal, and pneumococcal vaccinations should be current in patients who have had a splenectomy.
Antibiotic prophylaxis for women with recurrent uncomplicated UTIs, greater than 2-3/year, include low dose daily for 6 months: trimethoprin-sulfamethoxazole, trimethoprim, norfloxacin, ciprofloxacin, nitrofurantoin and cephalexin.
Postcoital antibiotics for female patients with UTIs should receive one dose of antibiotics daily, regardless of the frequency of intercourse.
Postcoital antibiotic prophylaxis can be managed with a single dose of cephalexin 250 mg or 50 mg of nitrifurantoin.
Washing children in intensive care units with chlorhexidine daily cuts the incidence of bacteremia by more than 35%. in a randomized, crossover trial.
The incidence of bacteremia in pediatric ICUs using the daily chlorhexidine baths was 3.28 per 1,000 patient-days, compared with 4.93 per 1,000 patient-days with standard bathing practices ( Milstone, A et al).