Randomized clinical trial of co-amoxiclav versus no antibiotic prophylaxis in varicose vein surgery

Abstract

Wound infection rates of up to 16 per cent are reported following varicose vein surgery and the value of antibiotic prophylaxis in clean surgery remains unclear. Some 443 patients undergoing varicose vein surgery randomly received a single prophylactic dose of 1.2 g co-amoxiclav (219 patients) or no antibiotic (224). Patients completed a wound diary on postoperative days 3, 5, 7, 9 and 10 using an adapted ASEPSIS method of wound assessment, and were reviewed after 14 days. Patients who had prophylaxis had lower ASEPSIS wound scores on days 3, 5 and 7 (P = 0.043, P = 0.032 and P = 0.003 respectively), and lower total ASEPSIS scores (median (interquartile range) 3 (0-9) versus 6 (0-15); P = 0.013). They were less likely to consult their general practitioner (16.0 versus 24.3 per cent; P = 0.040) or to receive postoperative antibiotics (4.7 versus 13.5 per cent; P = 0.002) for wound-related problems. Wound outcomes were worse with higher body mass index (odds ratio (OR) 0.92 (95 per cent confidence interval (c.i.) 0.87 to 0.97); P = 0.005) and current smoking (OR 0.5 (0.3 to 0.9); P = 0.033). Prophylactic antibiotics conferred satisfactory wound healing (OR 2.2 (95 per cent c.i. 1.3 to 3.6); P = 0.003). Antibiotic prophylaxis reduced wound-related problems after varicose vein surgery. Registration number ISRCTN12467340 (http://www.controlled-trials.com).