Principle of Prescription

Principle of Prescription


Prophylactic antimicrobial therapy should be restricted to situations in which it has been shown to be effective, or where the consequences would be disastrous.

Antimicrobials should be directed  against likely causative organisms, however it is not rational to attempt to cover all possible microbes.

Antibiotics for the purpose of prophylaxis should be administered at the time of anaesthetic induction, and to cover the period of surgery.

A second dose of antibiotic may be warranted if the operation continues beyond one half of the normal dosing interval for the agent being used.


Therapeutic Use of Antibiotics


Antibiotics should not be prescribed without discussion with the duty intensive care specialist.

The institution of empiric therapy prior to definitive bacteriological diagnosis should be based on local epidemiological data, potential pathogens and their known antimicrobial sensitivity patterns.

Whenever possible, samples (blood, sputum, urine or directly infected tissue) should be obtained before institution of antibiotics, however in life-threatening situations (e.g. meningitis), it may be appropriate to administer antibiotics immediately rather than delay pending culture.


Complications of Antibiotic Use

  • Drug hypersensitivity:  dermal eruptions, anaphylactoid / anaphylactic reactions

  • Drug toxicity:  idiosyncranatic (non-dose related) or dose related

      • Flucloxacillin-hepatotoxicity

      • Aminoglycoside-renal toxicity

  • Emergence of bacterial resistance

  • Selection on nosocomial colonizing organisms (and potential pathogens)

  • Pseudo membranous colitis


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Page last reviewed: 09 May 2014