Ampicillin combined with sulbactam or metronidazole for single-dose chemoprophylaxis in major gynaecological surgery.

Abstract

A double-blind, placebo-controlled and randomized trial involving a total of 295 patients was carried out to define the role of chemoprophylaxis in major gynaecological surgery in our hospital. Perioperative administration of a single dose of ampicillin (500 mg) plus sulbactam (500 mg) (regimen A), or ampicillin (500 mg) plus metronidazole (1 g suppository) (regimen B), gave similar results. After abdominal hysterectomy, the rates of post-operative wound infection and febrile morbidity were significantly reduced from 24% (12/49) and 20% (10/49) in the placebo group to 3-4% (A = 2/51, B = 3/58) and 2% (A = 1/51, B = 1/58) respectively. After vaginal hysterectomy, pelvic/vaginal infection or febrile morbidity was found in 30% (3/10) of patients in the placebo group but none in either treatment group (A = 10, B = 8). After other types of operation, the rates of infectious complications were reduced, but not statistically significantly, from 11% (4/38) to 4% (A + B 2/71). However, the rates of post-operative urinary tract infection remained similar in the placebo and treatment groups (12-16%).