Clinical Guideline for Antibiotic Prophylaxis Effective Tool for Surgeons

Guidelines regarding the use of prophylactic antibiotics (antibiotics given to avoid an infection rather than to treat one) in spinal surgery help spinal surgeons in using the antibiotics for the best outcomes possible. The authors of this article discuss how the guidelines came to be and graded the recommendations to show how effective the guidelines are.

Researchers broke down the development of the guidelines into 12 steps. For step one, doctors who were using the guidelines were asked to submit a list of questions that focused on concerns of using antibiotics prophylactically when doing spinal surgery. Step two was for orthopedic and neurology surgeons to answer the questions. Step three was for researchers to identify which search words and terms they needed to do a literature search and step four was doing the literature search. In step five, the researchers reviewed the abstracts they found in the literature search, step six summarized the conclusions, found strengths and weaknesses, and judged the level of evidence (strong down to weak).

In step 7, work groups looked at the if expert recommendations were needed. Step eight was when the guidelines were submitted to the North American Spine Society's Evidence Based Guideline Development Committee, the council director and an advisory panel. By step 10, revisions were approved. Step 10 saw the board submitting their guidelines to the over all guidelines clearinghouse. Step 11 is for recommendations to be submitted to the American Medical Association Physician Consortium for Performance Improvement. And, finally, step 12 is the recommendation that the guidelines be reviewed regularly at three-year intervals.

When looking through the literature, researchers were looking at the efficacy, protocol, redosing, discontinuation, wound drains, body habitus (shape and size), and comorbidities (other disorders that are also present) in order to back up the guideline recommendations. The study findings were graded on an A to C letter of recommendation or I to IV in level of evidence. On the whole, most studies scored a grade B for recommendation, while a few scored C. One study rated II as a level of evidence, three were level III, and another rated IV.

The authors found that the guidelines were developed with the best available evidence available in the literature and that the guidelines are useful to spinal surgeons in trying to prevent or reduce the risk of surgical infections.

William C. Watters, III, MD, et al. Antibiotic prophylaxis ins spine surgery: an evidence-basted clinical guideline for the use of prophylactic antibiotics in spine surgery. In The Spine Journal. February 2009. Vol. 9. No. 2. Pp. 142 to 146.

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