Ceftriaxone prophylaxis in reconstructive esophageal surgery: 5 years of clinical experience

Abstract

This study presents experience with the administration of intraoperative ceftriaxone prophylaxis in 85 patients who had major resective and reconstructive esophageal surgery. A total of 41 patients in whom the reconstructive procedures did not involve resective surgery received one intraoperative dose of ceftriaxone (250 mg to 1000 mg); another group of 44 patients who underwent resective, and reconstructive surgery received two intraoperative doses of ceftriaxone. In the latter group the doses were administered 30 minutes before transection of the viscera and before completion of the surgery. Because surgery was prolonged (3 to 10 hours) in these patients and was associated with operative blood loss of more than 1000 mL or 20% of the estimated blood volume, the second dose of antibiotic was given after control of active blood loss was achieved. After surgery, patients received a single daily dose of ceftriaxone for 5 or 6 days. The results obtained were satisfactory in each group of patients; one case of anastomotic leak was seen, but no case of wound infection was recorded. Based on these results, we suggest that the prophylactic administration of ceftriaxone be commenced intraoperatively and timed to achieve on optimal circulating concentration of the antibiotic when the clean operative wound inevitably becomes contaminated.