Comparison of selective and nonselective single-dose antibiotic cover in biliary surgery.

Abstract

AbstractA prospective randomized trial has compared 2 policies of single‐dose antibiotic prophylaxis in biliary surgery. Patients were randomly allocated to 1 of 2 regimens: in group A, all patients received a single dose (2 g) of mezlocillin; in group B, patients were only given a single dose (2 g) of mezlocillin if they could be identified as “high‐risk.” The high‐risk criteria used in group B patients were: emergency surgery, jaundice, age over 70, recent cholangitis, choledocholithiasis, or previous biliary surgery. Eighty‐five patients were randomized (random numbers) to group A and 84 patients to group B. Only 34 (40%) of the 84 patients in group B were high‐risk patients and these were the only patients who qualified for antibiotic cover. Septicemia occurred in 1 patient in each group. Wound sepsis occurred in 11 (13%) of the 84 patients in group B compared with only 2 (2.3%) of those in group A (p<0.02). These findings indicate that it is more advisable to provide single‐dose antibiotic prophylaxis to all patients having biliary tract surgery than to adopt a policy of “selective” antibiotic cover to high‐risk cases only.