Fluoroquinolones and Surgical Prophylaxis

Summary

The objective of surgical prophylaxis is to prevent wound infections associated with surgery. The rates of wound infections vary according to the procedure: less than 3 infections per 100 for clean procedures; up to 4 per 100 for clean-contaminated procedures; and up to 9 per 100 for contaminated procedures. Surgical antimicrobial prophylaxis has been shown in many randomised clinical trials to reduce the incidence of postoperative wound infections. Such prophylaxis is actually recommended in many clean-contaminated and some clean procedures.

Because of their antimicrobial, pharmacokinetic, and antiadhesive properties, the fluoroquinolones have been recently proposed as prophylactic agents. Fluoroquinolones have proved to be useful in surgical prophylaxis and clinical trials have been performed in orthopaedic, cardiovascular, biliary, colorectal and urological surgery. According to the surgical procedure, fluoroquinolones were compared either with the standard antimicrobial regimen or with placebo. Different regimens of fluoroquinolones were also compared. Generally, fluoroquinolones have been demonstrated to be as effective as the reference prophylactic agent. In transurethral surgery, fewer postoperative wound infections were reported in the treated group than in the placebo group. In most studies, single dose prophylaxis was as effective as a multiple dose regimen. It is important to note that strict methodology was limited to a few clinical trials. In most of the studies, patients were not randomised in a double-blind fashion and small patient numbers often prevented the formation of satisfactory conclusions.

Further trials are needed to define the role of the fluoroquinolones in surgical prophylaxis. It will be important to evaluate not only the efficacy but also the cost-benefit of perioperative prophylaxis with the fluoroquinolones. Clinical trials are also required in other high risk clean procedures such as neurosurgery involving shunts and ocular surgery. However, the risks related to the extensive use of fluoroquinolones in surgical prophylaxis must be considered, including the development and dissemination of resistant pathogens and the occurrence of adverse effects. In the future, surgical prophylaxis with prosthetic devices coated with fluoroquinolones should be considered.