Our patients do not need endocarditis prophylaxis for genitourinary tract procedures: insights from the 2007 American Heart Association guidelines. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Card Prophylaxis in gynaecological and obstetric surgery: a comparative randomised multicentre study of single-dose cefotetan versus two doses of cefazolin. Prevention of infection after induced abortion: release date October 2010: SFP guideline 20102. Universal prophylaxis compared with screen‐and‐treat for Chlamydia trachomatis prior to termination of pregnancy The absent role of prophylactic antibiotics in low-risk patients undergoing laparoscopic cholecystectomy. Use of antibiotic prophylaxis in elective inguinal hernia repair in adults in London and south-east England: a cross-sectional survey Recurrent urinary tract infection. Effect of lactobacillus in preventing post-antibiotic vulvovaginal candidiasis: a randomised controlled trial Does an enhanced recovery integrated care pathway (ICP) encourage adherence to prescribing guidelines, accelerate postoperative recovery and reduce the length of stay for gynaecological oncology patients? Antibiotic Prophylaxis in Hernia Repair and Breast Surgery: A Prospective Randomized Study Comparing Piperacillin/Tazobactam Versus Placebo Uncomplicated Bacterial Communityacquired Urinary Tract Infection in Adults. The effectiveness of non‐invasive complementary therapies in reducing postoperative nausea and vomiting following abdominal laparoscopic surgery in women: a systematic review [Antibiotic prophylaxis in the surgical treatment of inguinal hernia: need or habit?]. The effect of reimbursement on the use of antibiotics. ANTIBIOTIC PROPHYLAXIS IN LAPAROSCOPIC CHOLECISTECTOMY: IS IT WORTH DOING? Perioperative antibiotic prophylaxis in Spanish hospitals: results of a questionnaire survey. Hospital Pharmacy Antimicrobial Prophylaxis Study Group. The Role of Antibiotic Prophylaxis in Prevention of Wound Infection After Lichtenstein Open Mesh Repair of Primary Inguinal Hernia: A Multicenter Double-Blind Randomized Controlled Trial Effectiveness of Antibiotic Prophylaxis in Non-emergency Cholecystectomy Using Data from a Population-Based Cohort Study Antibiotic prophylaxis for hysteroscopy evaluation of the uterine cavity. Quality improvement of surgical prophylaxis in Dutch hospitals: evaluation of a multi-site intervention by time series analysis. Clinical consequences of infection in patients with acute stroke: is it prime time for further antibiotic trials? A randomised comparison of strategies for reducing infective complications of induced abortion
The 2007 American Heart Association guidelines for the prevention of infective endocarditis have dramatically reduced both the types of eligible procedures and the types of eligible cardiac lesions that require prophylaxis . Antibiotic prophylaxis to prevent infective endocarditis is not indicated for any patient undergoing obstetric and /or gynaecological procedures , not even for patients with underlying cardiac lesions with the highest risk of developing complications from endocarditis . This sharp departure from previously published guidelines relies on the recognition that endocarditis is more likely to develop from " r and omly occurring " bacteremia ( e.g. , from brushing teeth ) than from invasive procedures and that antibiotic prophylaxis has not been proven to be effective . A short discussion on enterococcal infections associated to obstetric and gynaecological procedures and therapeutic implication s is presented BACKGROUND The purpose of this statement is to up date the recommendations by the American Heart Association ( AHA ) for the prevention of infective endocarditis that were last published in 1997 . METHODS AND RESULTS A writing group was appointed by the AHA for their expertise in prevention and treatment of infective endocarditis , with liaison members representing the American Dental Association , the Infectious Diseases Society of America , and the American Academy of Pediatrics . The writing group review ed input from national and international experts on infective endocarditis . The recommendations in this document reflect analyses of relevant literature regarding procedure-related bacteremia and infective endocarditis , in vitro susceptibility data of the most common microorganisms that cause infective endocarditis , results of prophylactic studies in animal models of experimental endocarditis , and retrospective and prospect i ve studies of prevention of infective endocarditis . MEDLINE data base search es from 1950 to 2006 were done for English- language papers using the following search terms : endocarditis , infective endocarditis , prophylaxis , prevention , antibiotic , antimicrobial , pathogens , organisms , dental , gastrointestinal , genitourinary , streptococcus , enterococcus , staphylococcus , respiratory , dental surgery , pathogenesis , vaccine , immunization , and bacteremia . The reference lists of the identified papers were also search ed . We also search ed the AHA online library . The American College of Cardiology/AHA classification of recommendations and levels of evidence for practice guidelines were used . The paper was subsequently review ed by outside experts not affiliated with the writing group and by the AHA Science Advisory and Coordinating Committee . CONCLUSIONS The major changes in the up date d recommendations include the following : ( 1 ) The Committee concluded that only an extremely small number of cases of infective endocarditis might be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100 % effective . ( 2 ) Infective endocarditis prophylaxis for dental procedures is reasonable only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis . ( 3 ) For patients with these underlying cardiac conditions , prophylaxis is reasonable for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa . ( 4 ) Prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of infective endocarditis . ( 5 ) Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure . These changes are intended to define more clearly when infective endocarditis prophylaxis is or is not recommended and to provide more uniform and consistent global recommendations Antimicrobial prophylaxis is recommended in all clean-contaminated surgery where the critical threshold of number and virulence of the contaminating organisms with respect to host resistance is reached . Obstetric and gynaecological surgery is clean-contaminated and risk of infection due to aerobic and anaerobic bacteria without prophylaxis can be quantified at 30 - 40 % for vaginal hysterectomy , 10 - 35 % for abdominal hysterectomy and 10 - 34 % for caesarean section . To assess the role of two different cephalosporins as short term prophylaxis , we carried out a multicentre r and omised study involving a single 2 g i.v . dose of cefotetan in comparison with two doses of cefazolin ( 2 g i.v . before surgery and after 8 hours ) . Criteria for exclusion were : exposure to antibiotics within 7 days , preoperative infection , hypersensitivity to beta-lactams . Four hundred and sixty patients entered the study , of which 229 received  cefotetan and 231 cefazolin . No significant differences in mean age , obesity , preoperative weight loss , diabetes , type of disease , type of surgery ( vaginal or abdominal hysterectomies and caesarean sections ) and number of pregnancies and abortions existed between the two groups of patients . The total rate of infected patients undergoing hysterectomy  was 8.6 % ( 13/151 ) in the cefotetan group and 17.4 % ( 29/167 ) in the cefazolin group ( p less than 0.05 ) . This difference was due to cases of symptomatic bacteriuria and antibiotic retreatment , while wound infections were not significantly different ( 2.6 % and 1.8 % respectively ) . Among patients undergoing caesarean section , 9 of 78 ( 11.5 % ) and 7 of 64 ( 10.9 % ) were infected following cefotetan and cefazolin , respectively ( not significant ) . Cefotetan mean tissue concentrations in gynaecological organs were higher than those of cefazolin ( 25.5 - 44.8 vs. 7.4 - 9.5 mg/kg ) . ( ABSTRACT TRUNCATED AT 250 WORDS One known complication of induced abortion is upper genital tract infection , which is relatively uncommon in the current era of safe , legal abortion . Currently , rates of upper genital tract infection in the setting of legal induced abortion in the United States are generally less than 1 % . R and omized controlled trials support the use of prophylactic antibiotics for surgical abortion in the first trimester . For medical abortion , treatment-dose antibiotics may lower the risk of serious infection . However , the number-needed-to-treat is high . Consequently , the balance of risk and benefits warrants further investigation . Perioperative oral doxycycline given up to 12 h before a surgical abortion appears to effectively reduce infectious risk .  Antibiotics that are continued after the procedure for extended duration s meet the definition for a treatment regimen rather than a prophylactic regimen . Prophylactic efficacy of antibiotics begun after abortion has not been demonstrated in controlled trials . Thus , the current evidence supports pre-procedure but not post-procedure antibiotics for the purpose of prophylaxis . No controlled studies have examined the efficacy of antibiotic prophylaxis for induced surgical abortion beyond 15 weeks of gestation . The risk of infection is not altered when an intrauterine device is inserted immediately post-procedure . The presence of Chlamydia trachomatis , Neisseria gonorrhoeae or acute cervicitis carries a significant risk of upper genital tract infection ; this risk is significantly reduced with antibiotic prophylaxis . Women with bacterial vaginosis ( BV ) also have an elevated risk of post-procedural infection as compared with women without BV ; however , additional prophylactic antibiotics for women with known BV has not been shown to reduce their risk further than with use of typical pre-procedure antibiotic prophylaxis . Accordingly , evidence to support pre-procedure screening for BV is lacking . Neither povidone-iodine nor chlorhexidine have been shown to alter the risk of infection when used as cervicovaginal preparation . However , chlorhexidine appears to be more effective than povidone iodine at reducing bacteria within the vagina . The Society of Family Planning recommends the routine use of antibiotic prophylaxis , preferably with doxycycline , before surgical abortion . Use of treatment doses of antibiotics with medical abortion may decrease the rare risk of serious infection but universal requirement for such treatment has not been established Induced abortion is one of the most commonly performed gynaecological procedures in Great Britain , with over 12,000 terminations being performed annually in Scotl and and over 170,000 in Engl and and Wales . In Scotl and , 98 % of these are performed in NHS hospitals , whereas in Engl and and Wales , 51 % are performed in NHS hospitals and the remainder in the private sector or under NHS-funded agency agreements . Post-abortal pelvic inflammatory disease is a recognised complication of induced abortion and Chlamydia trachomatis is a pathogen which is commonly implicated in such cases . The prevalence of C. trachomatis among women requesting a termination of pregnancy in the UK has recently been reported to be 6–8 % . In order to reduce post-abortal infective morbidity from chlamydial infection and to prevent the long term sequelae ( infertility , ectopic pregnancy and pelvic pain ) , one of three management strategies may be adopted , namely , a screen- and -treat policy , universal antibiotic prophylaxis or a combined ‘ belt- and -braces approach ’ of both screening and prophylaxis . However , considerable controversy exists as to which strategy is most appropriate and , as a result , there is no agreed policy in the UK . There exists even further controversy as to whether a screen- and -treat strategy should include screening for pathogens other than C. trachomatis and as to which antibiotic regime is most suitable for a strategy of universal prophylaxis . In 1996 , the Royal College of Obstetricians and Gynaecologists recommended that for women undergoing induced abortion , a screen- and -treat strategy for C. trachomatis should include screening for gonorrhoea and bacterial vaginosis . Likewise , universal prophylaxis should use a regimen that was effective against C. trachomatis and anaerobic organisms associated with bacterial vaginosis . Since the prevalence of gonorrhoea has been shown to be only 0.2 % within this population , the necessity of screening for this pathogen in asymptomatic women is question able . As regards bacterial vaginosis , although the prevalence has been reported to be between 17 % and 28 % , its role in post-abortal pelvic infection remains unclear . C. trachomatis is more frequently detected in women with bacterial vaginosis than without and it has been postulated that bacterial vaginosis may facilitate the entry of chlamydia to the upper genital tract through the activity of enzymes such as mucinase and sialidase . A recent r and omised , placebo-controlled trial in women with bacterial vaginosis before surgical abortion provided weak evidence that treatment with metronidazole decreased the risk of post-abortal pelvic infection , although a chance finding could not be excluded . In addition , r and omised trials have shown no benefit in treating partners of women with bacterial vaginosis , so contact tracing would not be indicated for bacterial vaginosis . The remainder of this commentary will focus exclusively therefore on screen- and -treat versus prophylaxis strategies as relates to C. trachomatis only A retrospective chart review was done to determine the infection rate and the use of  prophylactic antibiotics  in consecutive laparoscopic cholecystectomies done in a single community .  Incisional infections were discovered in 11 of 566 cases , 10 of whom had received prophylactic antibiotics . The infected patients were significantly older , had longer procedures , and had more comorbidity than the uninfected patients . They were also more likely to have a palpable mass preoperatively and past biliary surgery . A second , prospect i ve study was done to evaluate the efficacy of the use of antibiotic prophylaxis in low-risk patients . Fifty-three patients were r and omized into two double-blinded groups . No incisional infections occurred in either group within 30 days postoperatively . This suggests prophylactic antibiotics are not needed to prevent infections for low-risk patients undergoing laparoscopic cholecystectomy Purpose Evidence regarding whether or not antibiotic prophylaxis is beneficial in preventing post-operative surgical site infection  in adult inguinal hernia repair is conflicting . A recent Cochrane review based on 17 r and omised trials did not reach a conclusion on this subject . This study aim ed to describe the current practice and determine whether clinical equipoise is prevalent . Methods Surgeons in training were recruited to administer the Survey of Hernia Antibiotic Prophylaxis usE survey to consultant-level general surgeons in London and the south-east of Engl and on their practice s and beliefs regarding antibiotic prophylaxis in adult elective inguinal hernia repair . Local prophylaxis guidelines for the participating hospital sites were also determined . Results The study was conducted at 34 different sites and received completed surveys from 229 out of a possible 245 surgeons , a 93 % response rate . Overall , a large majority of hospital guidelines ( 22/28 ) and surgeons ’ personal beliefs ( 192/229 , 84 % ) supported the use of  single-dose pre-operative intravenous antibiotic prophylaxis  in inguinal hernia repair , although there was considerable variation in the regimens in use . The most widely used regimen was intravenous co-amoxiclav ( 1.2 g ) . Less than half of surgeons were adherent to their own hospital antibiotic guidelines for this procedure , although many incorrectly believed that they were following these . Conclusion In the south-east of Engl and , there is a strong majority of surgical opinion in favour of the use of antibiotic prophylaxis in this procedure . It is therefore likely to be extremely difficult to conduct further r and omised studies in the UK to support or refute the effectiveness of prophylaxis in this commonly performed procedure OBJECTIVE to provide an up date of the definition , epidemiology , clinical presentation , investigation , treatment , and prevention of  recurrent urinary tract infections in women . OPTIONS continuous antibiotic prophylaxis , post-coital antibiotic prophylaxis , and acute self-treatment are all efficient alternatives to prevent recurrent urinary tract infection . Vaginal estrogen and cranberry juice can also be effective prophylaxis alternatives . EVIDENCE a search of PubMed and The Cochrane Library for articles published in English identified the most relevant literature . Results were restricted to systematic review s , r and omized control trials/controlled clinical trials , and observational studies . There were no date restrictions . VALUES this up date is the consensus of the Sub-Committee on Urogynaecology of the Society of Obstetricians and Gynaecologists of Canada . Recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care ( Table 1 ) . OPTIONS recurrent urinary tract infections need careful investigation and can be efficiently treated and prevented . Different prophylaxis options can be selected according to each patient 's characteristics Abstract Objective To test whether oral or vaginal lactobacillus can prevent  vulvovaginitis after antibiotic treatment . Design R and omised , placebo controlled , double blind , factorial 2 × 2 trial . Setting Fifty general practice s and 16 pharmacies in Melbourne , Australia . Participants Non-pregnant women aged 18 - 50 years who required a short course of oral antibiotics for a non-gynaecological infection : 278 were enrolled in the study , and results were available for 235 . Interventions Lactobacillus preparations taken orally or vaginally , or both , from enrolment until four days after completion of their antibiotic course . Main outcome measures Participants ' reports of symptoms of post-antibiotic vulvovaginitis , with microbiological evidence of c and idiasis provided by a self obtained vaginal swab . Results Overall , 55/235 ( 23 % ( 95 % confidence interval 18 % to 29 % ) ) women developed post-antibiotic vulvovaginitis . Compared with placebo , the odds ratio for developing post-antibiotic vulvovaginitis with oral lactobacillus was 1.06 ( 95 % confidence interval 0.58 to 1.94 ) and with vaginal lactobacillus 1.38 ( 0.75 to 2.54 ) . Compliance with antibiotics and interventions was high . The trial was terminated after the second interim analysis because of lack of effect of the interventions . Given the data at this time , the chances of detecting a significant reduction in vulvovaginitis with oral or vaginal lactobacillus treatment were less than 0.032 and 0.0006 respectively if the trial proceeded to full enrolment . Conclusions The use of oral or vaginal forms of lactobacillus to prevent post-antibiotic vulvovaginitis is not supported by these results . Further research on this subject is unlikely to be fruitful , unless new underst and ings about the pathogenesis of post-antibiotic vulvovaginitis indicate a possible role for lactobacillus A new integrated care pathway ( ICP ) proforma for gynaecological oncology patients was developed and introduced in early 2010 . The ICP is a goal -defined and time-specified documentation by gynaecological oncology doctors and nurses , guided by certain parameters to be achieved in pre and postoperative days . All patients were admitted to the same unit and underwent a major abdominal/pelvic procedure for confirmed or suspected gynaecological malignancy , including hysterectomy and oophorectomy . The control group included 58 r and omly selected patients from May 2008 to March 2009 and the intervention group comprised 52 patients , after the introduction of the ICP .  The effectiveness was assessed with a variety of measurements : the duration of intraperitoneal drains , urethral catheters and intravenous fluids postoperatively ; time taken for the patient to eat and drink ; time taken to mobilisation ; and the total length of stay in hospital . We also assessed whether the implementation of the care pathway was associated with an increase in adherence to prescribing guidelines for thromboprophylaxis and postoperative antibiotics and sodium docusate . The new ICP encouraged clearer documentation and regular review of fluids , drains and catheters . There was a modest reduction in the length of stay and an increase in prescribed thromboprophylaxis and sodium docusate ( 1 ) Abstract Although antibiotic prophylaxis is not explicitly indicated for hernia repair and breast surgery , its use for these clean procedures is widely adopted , albeit to a different extent in different countries , often on the personal decision of the individual surgeon . The present study was carried out to compare the efficacy of a single pre-operative dose of piperacillin-tazobactam with placebo in preventing surgical wound infections and to determine the main risk factors associated with infections following two main elective surgical clean procedures such as hernia repair and breast surgery . A total of 501 patients undergoing elective inguinal/femoral hernia repair or breast surgery were enrolled in this prospect i ve r and omized clinical study . Patients were r and omly assigned to receive preoperative antibiotic prophylaxis or placebo . One dose of piperacillin-tazobactam 2.250 g or placebo was administered i.v . 30 minutes prior to the surgical procedure . Using statistical univariate analysis , the following variables were correlated with a higher infection risk :  age > 40 years , concomitant disease , WBC < 3500 , surgical wound size > 9 cm , use of drainages , non-prophylaxis . Using multivariate analysis , no antibiotic pre-operative prophylaxis , concurrent chronic diseases , especially diabetes ( risk 15 times higher ) , and length of intervention > 45 min ( risk 6 times higher ) were independent predictors of infection . Finally , patients with postoperative infections  had a significantly longer hospitalisation . One pre-operative dose of piperacillin-tazobactam 2.250 g is more effective than placebo in preventing postoperative infections in breast surgery and hernia repair BACKGROUND Uncomplicated bacterial community-acquired urinary tract infection is among the more common infections in outpatient practice . The resistance level of pathogens has risen markedly . This S3 guideline contains recommendations based on current evidence for the rational use of anti - microbial agents and for the prevention of inappropriate use of certain classes of antibiotics and thus of the result ing drug resistance . The prevention of recurrent urinary tract infection is considered in this guideline for the first time . METHODS The guideline was up date d under the aegis of the German Urological Society ( Deutsche Gesellschaft für Urologie ) . A systematic literature search ( period : 2008 - 2015 ) concerning the diagnosis , treatment , and prevention of uncomplicated urinary tract infections was carried out in the Cochrane Library , MEDLINE , and Embase data bases . R and omized , controlled trials and systemic review s were included . Relevant guidelines were identified in a guideline synopsis . RESULTS Symptom-oriented diagnostic evaluation is highly valued . For the treatment of cystitis , fosfomycin-trometamol , nitrofurantoin , nitroxolin , pivmecillinam and trimethoprim are all equally recommended . Fluorquinolones and cephalosporins are not recommended . Uncomplicated pyelonephritis with a mild to moderate clinical course ought to be treated with oral cefpodoxime , ceftibuten , ciprofloxacin , or levofloxacin . For acute , uncomplicated cystitis , with mild to moderate symptoms , symptomatic treatment alone may be considered instead of antibiotics after discussion of the options with the patient . Mainly non-antibiotic measures are recommended for prophylaxis against recurrent urinary tract infection . CONCLUSION Physicians who treat uncomplicated urinary tract infections should familiarize themselves with the newly revised guideline 's recommendations on the selection and dosage of antibiotic treatment so that they can responsibly evaluate and plan antibiotic treatment for their affected patients Background Postoperative nausea and vomiting ( PONV ) are common adverse events following surgery and anaesthesia . The reported incidence is particularly high in patients undergoing laparoscopic surgery , ranging from 40‐77 % . PONV can be very distressing for patients and can result in unplanned readmission in ambulatory surgery . Antiemetics are only partially effective for both prophylaxis and treatment , can have adverse effects and in the case of the newer medications are expensive . The effectiveness of a number of complementary therapies in reducing the incidence of PONV continues to be investigated , given their relative ease of application , relatively low cost , lack of significant side effects , and patient interest and acceptability . Objectives The objective of this review was to determine from the available evidence the most effective non‐invasive complementary therapies for reducing the incidence and /or severity of postoperative nausea and vomiting in women undergoing abdominal laparoscopies . Search strategy A literature search was undertaken using : relevant health care data bases ( eg . AMED , CINAHL , MEDLINE / PubMed , Current Contents , Science Direct ) ; data bases of reports , theses , and conference papers ( eg Dissertation Abstract s , Conference Papers Index , National Research Register [ UK ] ) ; and major sources of evidence ‐based practice information ( e.g. Cochrane Library , Agency for Healthcare Research Quality , and clinical trials data bases or registers ) between the years 1980 and 2007 . In addition reference lists of relevant journal articles and selected web sites were checked . Selection criteria R and omised controlled trials and quasi‐experimental studies investigating the effects of non‐invasive complementary interventions on postoperative nausea and /or vomiting , and the need for rescue medication following abdominal laparoscopic surgery in women were considered for inclusion in the review . Trials with only a ' no‐treatment ' control group were not included . Data collection and analysis Assessment of the eligibility of studies for inclusion in the review and the method ological quality of eligible studies , and data extraction from included studies were undertaken independently by two review ers . Odds ratios and relative risks for dichotomous data and a weighted mean difference for continuous data were calculated with 95 % confidence intervals . Where pooling of data was inappropriate , studies were considered separately and a narrative summary reported . Main results Twenty‐one studies involving a total of 2286 participants were included in the review . Thirteen studies investigated the effect of four interventions on PONV following gynaecological laparoscopy : ginger , acupressure , guided imagery and music . Eight studies examined the effect of two interventions on PONV following laparoscopic cholecystectomy : stimulation of acupoints by various means and oral carbohydrate rich beverage . Six trials with a total of 554 participants investigated the effectiveness of varying dosages of ginger powder ( Zingiber officinale )  following gynaecological laparoscopy . There is some limited evidence to support providing ginger in doses between 1 g and 1.5 g to prevent or reduce the level of nausea postoperatively and to reduce the need for rescue medication whereas there is currently no evidence to support either a lower or higher dosage , i.e. < 1000 mg or > 1.5 g . Ginger in this dosage range ( 1‐1.5 g ) has not been demonstrated to be effective in preventing vomiting . Four trials , with a total of 399 participants , investigated the effectiveness of acupressure as prophylactic treatment for PONV in patients undergoing laparoscopic gynaecological procedures ; two using the P6 acupoint on the lower arm and two using the Korean K‐K9 acupoint on the h and . There is evidence that stimulation of the K‐K9 acupoint is effective , however the evidence for stimulating the P6 acupoint in this group of patients is equivocal . Six trials involving 719 participants investigated the effectiveness of stimulation of acupoints in patients undergoing laparoscopic cholecystectomy . There is some evidence to suggest that acupressure or acustimulation at P6 may be somewhat more effective in reducing nausea and vomiting following this surgical procedure for male and female patients . One study with 186 participants ( male and female ) assessed the application of capsaicin ointment to the Korean h and acupressure point K‐D2 . The treatment demonstrated efficacy in both the early ( 0‐6h ) and later periods ( 6‐24h ) for both the reduction of PONV and the need for rescue antiemetics . In treating established PONV postoperatively there were two trials , with a total of 172 participants , examining one category of intervention ‐ inhalation of isopropyl alcohol ( IPA ) . These two trials focusing on laparoscopic gynaecological procedures produced strong evidence that the administration of IPA is much quicker in achieving a 50 % reduction in the level of nausea than the antiemetic ondansetron ; however there is no evidence that it reduces the need for rescue antiemetics . The remaining three trials , two investigating oral carbohydrate rich beverage and the other guided imagery and music , did not demonstrate that these interventions were effective . Conclusions There is sufficient evidence to suggest that several of the interventions assessed could play a role in a multimodal approach to minimise PONV following abdominal laparoscopic surgery , albeit requiring further research to confirm that promise . The two interventions of note are the use of the Korean H and acupoints for prophylactic purpose s , particularly acupressure applied to the acupoint K‐K9 , and the use of impregnated pads for the inhalation of 70 % isopropyl alcohol to treat established nausea in females . There is also some evidence to suggest that acupressure or acustimulation at P6 may be effective in reducing nausea and vomiting in patients ( females and males ) having a laparoscopic cholecystectomy BACKGROUND Prophylactic antibiotics are recommended for clean-contaminated and selected contaminated surgery . In clean surgery antibiotics are suggested if the operation involves the insertion of prosthetic devices and a potential infection is expected to cause serious morbidity or mortality . Inguinal hernia repair is a clean operation , infections are rare ; they can usually be cured without removing the prosthesis and recurrence is uncommon even after removal of the mesh . Aim of the study is to evaluate whether the lack of antimicrobial prophylaxis increases the risk of postoperative infections in patients treated for groin hernia , compared to those treated with prophylaxis . METHODS One hundred and forty-eight patients underwent inguinal hernia repair with mesh : 64 patients ( 43 % ) received 2 g cefotaxime by intravenous bolus about 30 minutes before the operation , 84 patients ( 57 % ) did not receive any antimicrobic prophylaxis . Mean follow-up was 13 months ( range 1 - 31 months ) for both groups . RESULTS We did not observe any major complication . Among both groups , no patient had developed infection at one week and one month after surgery . CONCLUSIONS In personal experience , any advantage in terms of prevention of infections with antibiotic prophylaxis in patients operated on for groin hernia has been observed . A review of the literature showed no general agreement on this subject with different risk of infections in different trials . A new prospect i ve r and omized trial is necessary to clarify this topic OBJECTIVE To examine the effect of a reduction on the reimbursement of drugs on the use of antibiotics by general practitioners in Denmark . DESIGN A prospect i ve study using a question naire comparing the results with a similar study 3 years before , a period with normal reimbursement . PARTICIPANTS 553 general practitioners prescribed antibiotics for 5765 patients . MAIN OUTCOME MEASURE Number of treated patients and choice of antibiotics .  RESULTS 7607 patients were treated in 1987 compared with 5765 in 1990 , the relative number of patients treated for sinusitis , other upper respiratory tract infections , acute bronchitis , pneumonia and upper gynaecological infections was significantly less in 1990 than in 1987 . Other infections , particularly those that are often diagnosed by culture or microscopy by the general practitioners themselves , increased significantly . They included tonsillitis and urinary tract infections . CONCLUSION Reimbursement can be a very powerful tool controlling the use of antibiotics by general practitioners ABSTRACT Background : Elective laparoscopic cholecystectomy has very low risk for infectious complications , ranging the infection rate from 0.4 % to 1.1 % . Many surgeons still use routine antibiotic prophylaxis Aim : Evaluate the real impact of antibiotic prophylaxis in elective laparoscopic cholecystectomies in low risk patients . Method : Prospect i ve , r and omized and double-blind study . Were evaluated 100 patients that underwent elective laparoscopic cholecystectomy  divided in two groups : group A ( n=50 ) , patients that received prophylaxis using intravenous Cephazolin ( 2 g ) during anesthetic induction and group B ( n=50 ) , patients that did n't receive any antibiotic prophylaxis . The outcome evaluated were infeccious complications at surgical site . The patients were review ed seven and 30 days after surgery . Results : There was incidence of 2 % in infection complications in group A and 2 % in group B. There was no statistical significant difference of infectious complications ( p=0,05 ) between the groups . The groups were homogeneous and comparable . Conclusion : The use of the antibiotic prophylaxis in laparoscopic cholecystectomy in low risk patients does n't provide any significant benefit in the decrease of surgical wound infection A question naire survey was sent to a r and om sample of the Spanish network of National Health System public acute-care hospitals . Of responding institutions ( representing 25 % of Spanish hospital beds ) , nearly 75 % had active surveillance programs for the prevention and control of surgical-site infections ( SSIs ) , but only 20 % performed postdischarge surveillance . Overall ,  perioperative antibiotic prophylaxis ( PAP )  was used in 84 % of all surgical procedures . For 77 % of procedures , there were written guidelines for the choice and use of PAP . Cefazolin was the most commonly used antibiotic ( 38 % ) . Duration of PAP  was shorter than 24 hours in 75 % of procedures , and only a single dose was given in 52 % of procedures .  PAP  was commonly used in breast ( 52 % ) and inguinal hernia repair ( 69 % ) procedures , as well as in laparoscopic abdominal surgery ( 86 % ) . In summary , the use of PAP in Spanish hospitals is adequate , but improvements can be made in the frequency of prolonged PAP  and in the use of broad-spectrum antibiotics . Surveillance systems for SSI , including postdischarge follow-up , also should be improved Objective : To determine whether the use of prophylactic antibiotics is effective in the prevention of postoperative wound infection after Lichtenstein open mesh inguinal hernia repair . Summary Background Data : A recent Cochrane meta- analysis ( 2003 ) concluded that “ antibiotic prophylaxis for elective inguinal hernia repair can not be firmly recommended or discarded . ” Methods : Patients with a primary inguinal hernia scheduled for Lichtenstein repair were r and omized to a preoperative single dose of 1.5 g intravenous cephalosporin or a placebo .  Patients with recurrent hernias , immunosuppressive diseases , or allergies for the given antibiotic were excluded . Infection was defined using the Centers for Disease Control and Prevention criteria . Results : We included 1040 patients in the study between November 1998 and May 2003 . According to the intention-to-treat principle , 1008 patients were analyzed . There were 8 infections ( 1.6 % ) in the antibiotic prophylaxis group and 9 ( 1.8 % ) in the placebo group ( P = 0.82 ) . There was 1 deep infection in the antibiotic prophylaxis group and 2 in the placebo group ( P = 0.57 ) . Statistical analysis showed an absolute risk reduction of 0.19 % ( 95 % confidence interval , −1.78%–1.40 % ) and a number needed to treat of 520 for the total number of infections . For deep infection , the absolute risk reduction is 0.20 % ( 95 % confidence interval , −0.87%–0.48 % ) with a number needed to treat of 508 . Conclusions : A low percentage ( 1.7 % ) of wound infection after Lichtenstein open mesh inguinal ( primary ) hernia repair was found , and there was no difference between the antibiotic prophylaxis or placebo group . The results show that , in Lichtenstein inguinal primary hernia repair , antibiotic prophylaxis is not indicated in low-risk patients Abstract Background There is a variation in the administration of antibiotics prophylaxis to reduce the perceived risk of SSI in patients undergoing non-emergency cholecystectomy . The aim of this study was to determine the effectiveness of antibiotic prophylaxis following non-emergency cholecystectomy to prevent 30-day superficial surgical site infections ( SSIs ) using non-selected , nationally collected , prospect i ve data . Methods Data were extracted from the CholeS study , which examined and independently vali date d the outcomes on consecutive patients following non-emergency cholecystectomy across 166 hospitals in the UK and Irel and . Patients who received antibiotic prophylaxis were exact matched to those who did not on variables associated with antibiotic prophylaxis . The primary outcome of interest was superficial SSI , and secondary outcomes included deep SSI , readmissions , complications and re- interventions within 30 days . Results Out of a total of 7327 patients included in the study , 4468 ( 61 % ) received antibiotic prophylaxis . These were matched to patients who did not receive antibiotic prophylaxis on a range of demographic and surgical factors , leaving 1269 pairs of patients for analysis . Within this cohort , patients receiving antibiotic prophylaxis had significantly lower rates of superficial SSI ( 0.7 % vs. 2.3 % , p = 0.001 ) and all-cause complications ( 5.8 vs. 8.0 % , p = 0.031 ) , but similar rates of deep SSI ( 1.0 vs. 1.4 % , p = 0.473 ) , readmissions ( 5.2 vs. 6.2 % , p = 0.302 ) and re- interventions ( 2.6 vs. 3.7 % , p = 0.093 ) . The number needed to treat to prevent one superficial SSI was 45 ( 95 % confidence interval 24–662 ) . Conclusions Antibiotics appear effective at reducing SSI after non-emergency cholecystectomy . However , due to the high number needed to treat it is unclear whether they provide a worthwhile clinical benefit to patients OBJECTIVE To assess the prevalence of infectious complications and the protective effect of  prophylactic antibiotic treatment  after diagnostic office hysteroscopy in asymptomatic , infertile patients with normal results from transvaginal sonography . DESIGN Recording of infectious complications after routine hysteroscopy in the context of a r and omized controlled trial ; pseudor and omized , center-specific application of antibiotic prophylaxis . SETTING Two tertiary infertility care units . PATIENT(S ) Six hundred thirty-one unselected , asymptomatic , infertile women who underwent routine , diagnostic hysteroscopy prior to a first in vitro fertilization ( IVF ) or intracytoplasmic sperm injection treatment .  INTERVENTION(S ) Depending on the hospital and according to local protocol s , hysteroscopy was performed with or without antibiotic prophylaxis . MAIN OUTCOME MEASURE(S ) The prevalence of infectious complications after routine hysteroscopy .  RESULT ( S ) Of the 631 women who underwent routine , diagnostic hysteroscopy ,  antibiotic prophylaxis  was prescribed to 266 women , whereas 365 women underwent the procedure without prophylaxis . Only one infectious complication occurred ( 0.4 % ) in a patient who had not undergone therapeutic interventions and had taken antibiotic prophylaxis . This complication was successfully treated with antibiotics on an outpatient basis . CONCLUSION ( S ) Considering the extremely low risk of infectious complications and the lack of evidence , suggesting a beneficial effect of antibiotic prophylaxis , its use for routine , diagnostic office hysteroscopy should not be recommended OBJECTIVES Misuse of antibiotics in surgical prophylaxis is still quite common . The objectives of this study were to reduce the quantity and improve the quality of surgical prophylaxis and to reduce costs . METHODS Prospect i ve multi-site study of elective procedures in 13 Dutch hospitals . The quality of prophylaxis was audited before and after an intervention consisting of performance feedback and implementation of national clinical practice guidelines . Process outcome parameters were  antibiotic choice , duration , timing , antibiotic volume and costs . Segmented regression analysis was used to estimate the effect size of the intervention . Patient outcome was documented by the incidence of surgical site infections ( SSI ) . RESULTS Before the intervention , 1763 procedures were recorded and 2050 thereafter .  Antimicrobial use decreased from 121 to 79 DDD ( defined daily doses)/100 procedures and costs reduced by 25 % per procedure . After the intervention , antibiotic choice was inappropriate in only 37.5 % of the cases instead of in 93.5 % expected cases had the intervention not occurred . Prolonged prophylaxis was observed in 31.4 % instead of 46.8 % expected cases and inappropriate timing in 39.4 % instead of the expected 51.8 % . Time series analysis showed that all improvements were statistically significant ( P < 0.01 ) and that they could be fully attributed to the intervention . The overall SSI rates before and after intervention were 5.4 % ( 95 % CI : 4.3 - 6.5 ) and 4.6 % ( 95 % CI : 3.6 - 5.4 ) , respectively . CONCLUSIONS The intervention led to improved quality of surgical prophylaxis and to reduced antibiotic use and costs without impairment of patient outcome BACKGROUND AND PURPOSE It is unsettled whether stroke-associated infection ( SAI ) is an independent prognostic factor , and a recent clinical trial failed to show that antibiotic prophylaxis prevented SAI . Contrarily , this trial suggested that antibiotic prophylaxis impaired clinical recovery . We sought to evaluate the predisposing factors and clinical consequences of SAI to gather additional insight on the need of exploring other antibiotics in acute stroke . METHODS Between March 2001 and April 2002 , 229 consecutive patients were admitted into the neurological wards within 24 hours of stroke onset . Demographics , risk factors , National Institutes of Health Stroke Scale ( NIHSS ) score , vital data , imaging , and laboratory findings were prospect ively evaluated . SAI was treated as early as possible . Multivariate regression analyses assessed predisposing factors of SAI and the independent association between SAI and poor stroke outcome at day 7 ( Rankin > 2 ) . RESULTS Sixty ( 26 % ) patients developed SAI , most frequently chest infections , and within 3 days of stroke onset . Tube feeding ( odds ratio [ OR ] , 3.2 ; 95 % CI , 1.3 , 7.8 ) was the strongest predisposing factor of SAI . Poor outcome at hospital discharge was associated to baseline NIHSS score ( OR , 10.0 ; 95 % CI , 1.5 , 100 ) and tube feeding ( OR , 16.6 ; 95 % CI , 2.9 , 100.0 ) , adjusted for confounders including antibiotic use . SAI was not independently associated to poor outcome ( OR , 0.9 ; 95 % CI , 0.9 , 1.0 ) . CONCLUSIONS SAI is a marker of the severity of stroke without an independent outcome effect when it is promptly treated . These results support current stroke guidelines that advise prompt treatment of infection and warn against antibiotic prophylaxis . Yet , these recommendations should not prevent the performance of acute stroke trials assessing the value of antibiotics with acknowledged neuroprotective properties OBJECTIVES To determine lower genital tract carriage rates of C. trachomatis , N. gonorrhoeae and bacterial vaginosis among women seeking termination of pregnancy . To compare two clinical management strategies for minimising the risks of infective morbidity after induced abortion . DESIGN Prevalence of infections was assessed by screening women undergoing abortion . Clinical management strategies were compared by a r and omised trial . SETTING The gynaecology departments of four hospitals in Scotl and . PARTICIPANTS 1672 women undergoing induced abortion . INTERVENTIONS Women r and omised to prophylaxis received metronidazole 1 g rectally before abortion plus doxycycline 100 mg twice daily for seven days . Women r and omised to screen- and -treat received appropriate antibiotics only if screening proved positive for one or more infection . MAIN OUTCOME MEASURES Prevalences of infections ; morbidity in the eight weeks following abortion as assessed by reported symptoms , general practitioner consultation and prescription rates and hospital re-attendances ; costs to the NHS of alternative managements . RESULTS Prevalence rates : C. trachomatis 5.6 % ; N gonorrhoeae 0.19 % ; bacterial vaginosis 17.5 % . Overall , women allocated to receive prophylaxis had lower rates of measures of short term infective morbidity than those allocated to screen- and -treat . These differences only reached statistical significance for women who were reported negative on screening . The direct costs to the NHS of prophylaxis and screen- and -treat were calculated to be 8.17 and 18.34 per woman , respectively . CONCLUSIONS Prevalences of lower genital tract infections which have been implicated in increased rates of infective morbidity after abortion are similar to those reported elsewhere . Universal antibiotic prophylaxis is at least as effective as a policy of screen- and -treat in minimising the risk of short term infective morbidity and is far more cost efficient
Benefits , harms , and costs Guideline implementation should result in a reduction of cost and related harm of administering antibiotics when not required and a reduction of infection and related morbidities when antibiotics have demonstrated a proven benefit .
Abstract Objective To review the evidence and provide recommendations on antibiotic prophylaxis for gynaecologic procedures .
Outcomes Outcomes evaluated include need and effectiveness of antibiotics to prevent infections in gynaecologic procedures .