Prophylactic antibiotic usage in clean surgical procedures.

The article is a review of the results of a method of use of prophylactic antibiotic therapy in 2278 clean procedures performed by the author from 1959 to 1981. The procedures analyzed are mastectomy, cholecystectomy, inguinal hernia repair, incisional hernia repair, laparotomy, and thyroidectomy. These cases are considered separately and compared with other detailed series in the literature. The author feels that the infection rate of 0% in this series when compared to rates of 1.7 per cent to 5 per cent in the literature for the same type of cases warrants use of this method. The major points in the method are 1) use of topical irrigating solution of 0.5 per cent neomycin sulfate; 2) beginning proper intravenous antibiotic administration when the patient reaches the recovery room; 3) limit the use of antibiotic to 3 days past the day of surgery unless drains or hemovacs are still in place, in which case the antibiotic is continued for 24 hours after their removal; 4) careful and strict daily examination and evaluation of the patient in order to discontinue the antibiotic at the outset of any problems; 5) continued strict adherence to basic surgical principles throughout the entire surgical experience of the patient.