Doctors over-prescribe antibiotics all the time. Doctors know the recommendations and rules, but sometimes they ignore them.
Side effects from antibiotic use, such as the damage to the natural flora of the intestinal and reproductive tracts don’t make it on page 8 of the newspaper.
But it’s front page news when a patient dies from using a Neti Pot (one of the best treatments available for sinusitis) with a brain eating fungal infection.
Patients feel that an antibiotic is essential to treat all infections when in reality most infections are viral and will resolve with rest and fluids. Even so, patients press for the medications.
In my practice, patients routinely ask “don’t I need an antibiotic after surgery?” My answer – No.
Antibiotics are used pre-operatively within 30 minutes of incision time to prevent infections from surgery. Antibiotics given post-operatively have not been shown to decrease the rate of infection, so I don’t prescribe them. If there is no added benefit from antibiotics, then there can only be added complications. One of the most important goals of surgery is to avoid complications.
There are other ways of preventing infections, such as:
- Meticulous and gentle surgical technique
- Strict adherence to sterile precautions
- Avoiding contamination of the wound with sterile but irritating materials intra-operatively
- Minimal use of electrocautery devices to control bleeding
I have used the above techniques for 15 years. But until recently, my patients suffered rates of infection and wound problems just slightly less than the national average. On January 24th, 2012, I discontinued the use of Vicryl from my surgical sites. Since then I have had zero primary wound infections requiring a return to the operating room. This is amazing.
Even more amazing, I have placed very few patients on oral antibiotics to treat post-operative cellulitis.
When some reports quote as high as a 14% rate of infection requiring antibiotics and/or return to the OR, it makes me stand up and notice.
Related Sources:
medscape.com
