Surgical antibiotic prophylaxis: tradition and change.

The use of antibiotic surgical prophylaxis in the prevention of postoperative infection is now well accepted. It is also agreed that prophylactic antibiotics are only effective if given before surgery. This allows time for the antibiotics to concentrate in the blood before being incorporated into fibrin clots at the wound site after surgery. Despite the widespread use of antibiotic surgical prophylaxis, the incidence of surgical site infection remains high. Poor adherence to guidelines, resulting from conflicts of interest between hospital departments, and the inappropriate use of antibiotics has been blamed. Cooperation and consensus between physicians, pharmacists and surgeons is required if antibiotic misuse is to be reduced. Locally developed antibiotic practice guidelines, designed, in part, by computer-assisted decision-making systems, offer the best way of monitoring and improving prophylactic antibiotic efficacy and compliance.