Antibiotics in Surgery

Because World War II soldiers suffered fewer serious wound infections if they got prompt penicillin treatment, surgeons got the idea that patients could be protected against infections if they were given a hefty dose of antibiotics at the time of operation. Not so, says Scottish-trained Surgeon Frederick R. C. Johnstone. Far from giving added protection, this prophylactic use of antibiotics introduces extra hazards in the vast majority of civilian cases.

For 2 1/2 years, Dr. Johnstone kept detailed records of every dose of antibiotics given to patients in a test ward in Vancouver General Hospital. University surgeons did the operations and prescribed what they thought best. Of 1,020 patients whose wounds were not infected to begin with, 401 got prophylactic antibiotics, while 619 got none. In Surgery, Gynecology & Obstetrics, Dr. Johnstone reports the astonishing result: among those who got the antibiotics, 25% developed infections--almost three times the rate for the other patients. There were four times as many infections caused by staphylococci. Those World War II battlefield germs, notes Dr. Johnstone, were far easier to kill.

Dr. Johnstone concludes that only in special cases, such as surgery of the bowel, where microbes are an immediate threat, should antibiotics be given prophylactically, and then only for a short time. In other cases, he believes, antibiotics kill off the weaker germs and leave the field wide open for the more dangerous bacilli to multiply.

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