Trends in the Use of Antibiotics in Thoracic Surgery

Antibiotics have revolutionized thoracic surgery. As yet streptomycin and penicillin far outweigh the other antibiotics in their value to the thoracic surgeon.

Because resistance to streptomycin develops rapidly and is permanent, this antibiotic should not be used indiscriminately, but should be restricted to specific indications. The use of streptomycin as an adjunct in tuberculosis surgery has extended operative indications, and has made possible safer and more effective pulmonary resection, decortication, cavernostomy, closure of tuberculous sinuses, and pericardectomy. The administration of 1 gram a day, in one or two doses, is recommended for periods of six weeks on less.

In the light of present knowledge the use of streptomycin would not seem justified in routine thoracoplasty, inasmuch as complications are already minimal. Its use is rarely justified in other forms of collapse therapy.

Penicillin has proved of particular value in the surgery of bronchiectasis and lung abscess, in thoracic trauma, in exploration for intrathoracic tumors, in esophageal surgery, and in surgery of the heart and great vessels.

The present trend is toward larger doses of penicillin, with penicillin G potassium the preparation of choice in active infection. In surgery, repository and aerosol penicillin are primarily applicable in prophylaxis.