Contributed by: Dr. Akilesh Ramasamy & Dr. Tamhankar
Due to increasing levels of antibiotic resistance, the routine use of post surgical antibiotics is being questioned in various specialties. For instance, I have already pointed out in my review (1) that use of antibiotics after routine or even complicated tooth extractions in dentistry do not require routine use of antibiotics unless accompanied by space infections. Other surgical specialties also have come up with guidelines in this regard. In a recent multi-centric study involving urosurgical procedures, the investigators started following the guidelines of using only prophylactic antibiotics prior to the procedure. No post surgical antibiotics were used in the post operative period.
Comparing the infection rates retrospectively with previous cases (where antibiotics were used routinely in the post operative period), they found that the infection rates among the two groups did not differ significantly, suggesting that routine use of antibiotics is not necessary.(2)
Antibiotic use is associated with increased costs of treatment, more antibiotic related adverse events and development of antibiotic resistance. So, avoiding antibiotics for unnecessary indications can cut down on the costs, complications and antibiotic resistance. This is important on two main fronts. First, the cost of healthcare is ever increasing. Wastage in the ways of unnecessary treatments / antibiotics can decrease the costs of healthcare. India's Health Policy 2015 Draft aims to make healthcare accessible and affordable. In this regard we must take action and note to cut down on unnecessary prescriptions, unnecessary diagnostic tests and unnecessary procedures. Not only do they add to the costs of the treatment but also are potential issues of patient safety. Every procedure, test or medication adds to possible risks in the treatment of the patient. So avoiding those that are not essential can also contribute to safer high quality care with minimal wastage of resources.
(1) Ramasamy, Akilesh. “A Review of Use of Antibiotics in Dentistry and Recommendations for Rational Antibiotic Usage by Dentists.” The International Arabic Journal of Antimicrobial Agents 4.2 (2014): imed.pub. http://dx.doi.org/10.3823/748
(2) European Association of Urology. "Changes in surgery methods significantly reduces antibiotic resistance." ScienceDaily. ScienceDaily, 20 March 2015. <www.sciencedaily.com/releases/2015/03/150320221049.htm>