We are grateful to Drs. Roth and Tewari et al.  for their constructive comments. Dr. Roth points out additional compelling reasons for the anesthesiologist to be involved with antibiotic administration. Although some anesthesiologists may resist this involvement, the potential benefit to surgical patients is difficult to ignore.

Dr. Tewari et al.  correctly point out, “With this responsibility comes accountability.” By providing our faculty with a protocol developed by our infection control committee, we have attempted to separate the responsibility of drug administration from that of drug selection. We disagree that a concerted effort should be made to educate anesthesiologists on antibiotic selection, because we believe this is beyond the scope of our expertise. We do willingly accept responsibility for appropriate administration, but not selection of the appropriate drug.

The response to our letter in which we described our policy for antibiotic administration has been overwhelming.1We have received hundreds of e-mails requesting our protocol, and we have attempted to oblige all requests.

Our experience in formulating a protocol for antibiotic administration with our infection control committee has been very positive. Although our protocol serves as an example, we encourage involvement of institutional infection control experts in the development of institution- and geographic-specific protocols, because their expert knowledge of infectious agents, local sensitivities to antibiotics, and the constantly expanding antibiotic choices will enhance appropriate recommendations for perioperative antibiotic prophylaxis.

* The University of Texas Medical School at Houston, Houston, Texas. robert.d.warters@uth.tmc.edu

Warters RD, Szmuk P, Pivalizza EG, Gebhard R, Ezri T: Preoperative antibiotic prophylaxis: The role of the anesthesiologist. Anesthesiology 2003; 99:515–6