Prophylaxis Of Postoperative Infections Research Articles

A Comparative Review of the Efficacy of 24-HourVersus 48-Hour Dose Regimen of Amoxicillin/Clavulanic Acid Prophylaxis forpostoperative infections following elective Caesarean Section at the University College Hospital, Ibadan, Nigeria: A Randomized Clinical Trial

Objectives: To compare the efficacy of 24hour versus 48hour prophylaxis of amoxicillin/clavulanic acid in the prevention of postoperative infections. Study Design: This study was a randomized controlled clinical trial conducted in a tertiary hospital in Ibadan, Nigeria. Two hundred and fifty -two pregnant women scheduled for elective caesarean section were randomly assigned into two groups. After the initial pre-incision antibiotic administration, group A received the Amoxicillin/Clavulanic Acid for 24 hours while group B received the same drug for 48hours. Main Outcomes: Participants were examined on the 3rd, 10th and 17th post-operative days for evidence of infections. All entry and analysis of data was by computer using the Statistical Package for Social Sciences version 22 (IBM, New York). Statistically significant differences were determined at p value of < 0.05. Results: The incidence of postoperative wound infection, postoperative fever and endometritis in this study was 5.2%, 9.1% and 5.6% respectively. There was no significant differences in the incidence of postoperative wound infection, postoperative fever and endometritis between the two regimens of antibiotics. Conclusion: A 24-hour prophylactic regimen of amoxicillin/clavulanic acid is adequate following caesarean section and prolonged use of antibiotics is generally unnecessary, costly and inadvertently increases antibiotics resistance

Probiotics as Prophylaxis for Postoperative Infections of Under-five Children Following Gastrointestinal Surgery.

Evaluation of the efficacy of use of probiotics as prophylaxis for postoperative wound infection in under-five children following gastrointestinal surgery. This randomized control trial was conducted over a period of 2 years in the pediatric surgery units of a tertiary level hospital in Dhaka, Bangladesh. A total of 60 patients undergoing gastrointestinal surgery under the age of 5 years were included in the study and randomly assigned to two groups - probiotics group (n = 30) and nonprobiotics group (n = 30). Patients in the probiotics group received probiotics in the preoperative (3 days) and postoperative period (7 days) along with traditional gut preparation (antibiotics and mechanical bowel wash). Patients in the nonprobiotic group got only antibiotics and traditional gut preparation. Outcome variables were surgical site infection, fever, c-reactive protein (CRP), total white blood cell (WBC) count, and neutrophil count. Postoperative wound infection was less in the probiotic group (n = 2) compared to the nonprobiotic group (n = 3), but the difference was not statistically significant (P = 0.640). Postoperative CRP level was significantly lower in the probiotics group (P = 0.020). There was more decline in total count of WBCs in postoperative period in the probiotic group. No statistical difference was seen between the groups in postoperative pyrexia, the total count of WBC, and neutrophil count. Use of probiotics along with traditional gut preparation as prophylaxis for postoperative infection in children showed no added benefit in comparison to the use of traditional gut preparation only.

Adhesive incisional drapes during cesarean delivery for preventing wound infection: A systematic review and meta-analysis of randomized controlled trials.

ObjectiveTo compare the incidence of wound infection after cesarean delivery in procedures conducted using adhesive incisional drapes verses no adhesive incisional drapes.Study DesignSearches were performed in electronic databases (MEDLINE, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, Scopus, OVID, EMBASE, and the PROSPERO International Prospective Register of Systematic Reviews). We included randomized controlled trials comparing adhesive incisional drapes to no adhesive incisional drapes during cesarean delivery. The primary outcome of this meta-analysis was wound infection. Meta-analysis was performed using the random effects model of DerSimonian and Laird, to produce relative risk (RR) with 95% confidence interval (CI).Results52 publications were identified through initial search of databases and two randomized controlled trials were eligible and included in the meta-analysis. Our meta-analysis examined a total of 1943 subjects and showed a statistically significant increase in wound infections in patients in the adhesive incisional drape group when compared to the control group (RR: 1.29, 95% CI: 1.02–1.65).ConclusionAdhesive incisional drapes may increase the incidence of wound infections after cesarean delivery. Further studies are necessary to explore this relationship in the setting of current postoperative infection prophylaxis, including broad-spectrum antibiotic coverage, skin preparation and vaginal cleansing.

Current Strategies in Prevention of Postoperative Infections in Spine Surgery

Study Design:Narrative review.Objectives:Postoperative surgical site infections (SSIs) are among the most common acute complications in spine surgery and have a devastating impact on outcomes. They can lead to increased morbidity and mortality as well as greater economic burden. Hence, preventive strategies to reduce the rate of SSIs after spine surgery have become vitally important. The purpose of this article was to summarize and critically analyze the available evidence related to current strategies in the prevention of SSIs after spine surgery.Methods:A literature search utilizing Medline database was performed. Relevant studies from all the evidence levels have been included. Recommendations to decrease the risk of SSIs have been provided based on the results from studies with the highest level of evidence.Results:SSI prevention occurs at each phase of care including the preoperative, intraoperative, and postoperative periods. Meticulous patient selection, tight glycemic control in diabetics, smoking cessation, and screening/eradication of Staphylococcus aureus are some of the main preoperative patient-related preventive strategies. Currently used intraoperative measures include alcohol-based skin preparation, topical vancomycin powder, and betadine irrigation of the surgical site before closure. Postoperative infection prophylaxis can be performed by administration of silver-impregnated or vacuum dressings, extended intravenous antibiotics, and supplemental oxygen therapy.Conclusions:Although preventive strategies are already in use alone or in combination, further high-level research is required to prove their efficacy in reducing the rate of SSIs in spine surgery before evidence-based standard infection prophylaxis guidelines can be built.

Preparación mecánica y profilaxis antibiótica por vía oral en cirugía colorrectal. Análisis de la evidencia científica y revisión narrativa

The role of oral antibiotic prophylaxis and mechanical bowel preparation in colorectal surgery remains controversial. The lack of efficacy of mechanical preparation to improve infection rates, its adverse effects, and multimodal rehabilitation programs have led to a decline in its use. This review aims to evaluate current evidence on antegrade colonic cleansing combined with oral antibiotics for the prevention of surgical site infections. In experimental studies, oral antibiotics decrease the bacterial inoculum, both in the bowel lumen and surgical field. Clinical studies have shown a reduction in infection rates when oral antibiotic prophylaxis is combined with mechanical preparation. Oral antibiotics alone seem to be effective in reducing infection in observational studies, but their effect is inferior to the combined preparation. In conclusion, the combination of oral antibiotics and mechanical preparation should be considered the gold standard for the prophylaxis of postoperative infections in colorectal surgery.

Mechanical Bowel Preparation and Oral Antibiotic Prophylaxis in Colorectal Surgery: Analysis of Evidence and Narrative Review

The role of oral antibiotic prophylaxis and mechanical bowel preparation in colorectal surgery remains controversial. The lack of efficacy of mechanical preparation to improve infection rates, its adverse effects, and multimodal rehabilitation programs have led to a decline in its use. This review aims to evaluate current evidence on antegrade colonic cleansing combined with oral antibiotics for the prevention of surgical site infections. In experimental studies, oral antibiotics decrease the bacterial inoculum, both in the bowel lumen and surgical field. Clinical studies have shown a reduction in infection rates when oral antibiotic prophylaxis is combined with mechanical preparation. Oral antibiotics alone seem to be effective in reducing infection in observational studies, but their effect is inferior to the combined preparation. In conclusion, the combination of oral antibiotics and mechanical preparation should be considered the gold standard for the prophylaxis of postoperative infections in colorectal surgery.

Intracameral moxifloxacin for prophylaxis of postoperative endophthalmitis

The aim of this study was to evaluate the rates of post-cataract-surgery endophthalmitis after prophylactic intracameral moxifloxacin administration. In this retrospective descriptive study, 1013 uncomplicated cataract surgeries with intraocular lens implantation were performed between March 2009 and November 2013 by one surgeon (AP). Each patient received an intracameral injection of 0.05 ml undiluted 0.5% moxifloxacin for prophylaxis of postoperative infection. The mean follow-up of patients was 1 year (range: 2 months to 4 years), and the mean age of the patients was 64.2 years (range: 38–99 years). Of the 1013 patients, 617 (58.6%) were women. No case of endophthalmitis occurred. No postoperative endophthalmitis was observed after the intracameral injection of 0.5% moxifloxacin ophthalmic solution during routine cataract surgery.

Use of Probiotics as Prophylaxis for Postoperative Infections of Under- 5 Children Following Gastrointestinal Surgery

Background: Bacterial infection is a frequent complication following operations in the gastrointestinal tract. Despite prophylactic administration of antibiotics the incidence of postoperative infections ranges from 10%–30% in resection surgery.1 Most infections are caused by bacteria of enteric origin.2 In spite of restricted use of prophylactic antibiotics, the emergence of antibiotic resistance has increased significantly.3 Probiotics when consumed in adequate amounts, confer a health benefit on the host. In vitro, studies suggest that probiotics potentially act favorably on the host through several different mechanisms. They have an antimicrobial effect. Furthermore, administration of probiotics suppresses growth of potentially pathogenic microorganisms, e.g., E. coli and Enterobacteriaceae. The effects of these agents may go beyond the gastrointestinal tract to distant areas, such as the urogenital and respiratory mucosa. It has been hypothesized by several authors that these characteristics can be used in a clinical setting of preoperative prophylaxis for reduction of postoperative infections. Preoperative antibiotic prophylaxis constitutes more than 10% of antibiotic usage in surgery and a reduction could lead to a reduced pressure on development of antibiotic resistance. It may therefore be of interest to study if probiotics may be used in the preoperative preparation of patients undergoing gastrointestinal operations.Objective: The overall objective of this study is to evaluate the effectiveness of probiotics as prophylaxis for post operative infections in under-5 children undergoing gastrointestinal surgery. Materials and methods: We are conducting a prospective comparative study with the intention to observe the postoperative periods of 60 purposively selected patients of gastrointestinal surgery in the Department of Pediatric surgery, Dhaka Medical College Hospital (DMCH), Dhaka, over a period of 18 months from October, 2013 to March, 2015. The patients are going to be divided into 2 groups by random sampling- Group A (Control group- without probiotics) and Group B (Study group- with probiotics). Under-5 children are planned to be selected as study subjects. All children are subjected to investigate for white blood cell (WBC) count and Creactive protein (CRP) preoperatively and on 5th postoperative day (POD) in addition to routine investigations. Structured questionnaire is used to collect information regarding fever, surgical site infection, WBC and CRP count before operation and 5 days after operation (i.e. on 5th POD). Informed written consent from parents or legal guardian is taken after describing the study objectives. Ethical clearance has been sought from the Ethical Committee of Dhaka Medical CollegeResults: Total 8 patients are studied till now, 4 in each group. From this limited data we have observed that there has been apparently minimum difference between the cases and controls regarding postoperative infections.Discussion: Post operative wound infections are quite common and an important reason for administering antibiotics for prolonged periods.13 Probiotics given preoperatively tends to reduce the incidence of post operative infection, though the accurate mechanism is not known. The use in patients undergoing colorectal surgery does not seem to show any benefit.18 The result of our study until now has not demonstrated any added benefit of prophylactic use of probiotis in the specified age group. So up to now the available data is compatible with the various data seen in other studies.18 In our study, it is very early to comment on the results.Conclusion: This is an on-going study. Definite conclusion could not be drawn at this preliminary stageJ. Paediatr. Surg. Bangladesh 4(2): 38-43, 2013 (July)

Analysis of conjunctival bacterial flora in the preparation of patients for cataract surgery

In most cases, microorganisms responsible for intraocular infection are identical to the organisms on the ocular surface of the patient's ocular adnexa. The preoperative and postoperative infection prophylaxis aims to reduce the risk of infection from bacterial flora of the eye and adnexa and to eliminate bacteria that can contaminate the wound during surgery. The aim of our study was the microbiological analysis of the bacterial flora of the conjunctiva, preoperative eradication in terms of prophylaxis of endophthalmitis following cataract surgery and to determine the effectiveness of ofloxacin 0.3 % in bacteria reduction. The study included 120 patients suffering from senile cataract selected at the Department of Ophthalmology, Clinical Centre Niš, divided into two groups of 60 patients. The control group of 60 patients did not receive antibiotics preoperatively. The second group of 60 patients was treated topically with ofloxacin 0.3% in the form of drops, four times a day for four days prior to surgery, and four times for two hours prior to surgery. Examination of the conjunctival flora was carried out using standard microbiological procedures. The conjunctival swabs were collected from all patients at the time of the selection for surgery (the first swab), four days prior to surgery (second swab) and immediately before the operation and on entering the operating room (third swab). In the control group of patients, the first and second conjunctival swabs were positive in 9 and negative in 51 patients. The third swab findings did not change (9 positive and 51 negative swabs). There was no statistically significant difference between the findings of the first, second and third swabs of patients in the control group (χ2 test, p>0.05). In the therapy group of patients, the first and second conjunctival swabs were positive in 6 cases and negative in 54 patients. Detection of the third sample from this group was sterile in all 60 patients. There was a statistically significant difference between the findings of the second and third swabs of patients in the treatment group, ie. there was a correlation between the response to therapy and the outcome of patients (χ2 test, p<0,05). Among the 15 positive conjunctival swab findings the most common cause of infection were Staphylococcus aureus (6 swabs) and Staphylococcus epidermidis (5 swabs), Enterobacter spp. (2 swabs), Proteus mirabilis and Pseudomonas aeruginosa in one swab respectively. Topical ofloxacin 0.3 % for four days prior to surgery, and four times in two hours before the operation is effective in the elimination of the bacterial flora of the conjunctiva and the sterility is achieved in all cases.

Clinical evaluation of cefoxitin in surgery

Cefoxitin (CFX) was administered to 13 patients who were admitted to the surgical ward of the hospital. The results of the study as follows; Disc susceptibility tests of the 11 strains isolated from the patients to antibiotic were performed and 10 strains showed good susceptibility to CFX. The clinical response was good in all 4 patients with surgical infections. It is noted that 1 patient with mixed infection caused by E. coli, Clostridium sp. and Bacteroides sp. showed good response to CFX. Out of 9 patients treated with CFX for prophylaxis of postoperative infections, 8 patients responded effectively to CFX, and clinical efficacy rate was 88.9%. No side effects were noted due to CFX. It is considered from these results of the study that CFX is a highly effective and safe drug for treatment of infections and for the prevention of postoperative infections in surgery.

Clinical studies on cefoxitin in the field of obstetrics and gynecology

Clinical studies were done on cefoxitin (CFX), the first cephamycin antibiotic, in the field of obstetrics and gynecology and following results were obtained. CFX was administrated by intravenous drip infusion for average 6.9 days at a daily dose of 2--6 g to 58 patients; 15 with intrauterine infections, 5 with intrapelvic infections, 11 with adnexitis, 3 with mastitis, 5 with urinary tract infections, 2 with other infections and 17 for prophylaxis of postoperative infections. The clinical results were excellent in 8 cases, good in 39 cases, fair in 4 cases, poor in 6 cases and unknown in 1 case, with the efficacy of 82.5%. Total bacteriological effective rate was 88.9%. As to side effects, eruption was observed only in 1 case. From the results of the present study, the usefulness of CFX was demonstrated in the field of obstetrics and gynecology.

Use of Probiotics as Prophylaxis for Postoperative Infections

Postoperative bacterial infections are common despite prophylactic administration of antibiotics. The wide-spread use of antibiotics in patients has contributed to the emergence of multiresistant bacteria. A restricted use of antibiotics must be followed in most clinical situations. In surgical patients there are several reasons for an altered microbial flora in the gut in combination with an altered barrier function leading to an enhanced inflammatory response to surgery. Several experimental and clinical studies have shown that probiotics (mainly lactobacilli) may reduce the number of potentially pathogenia bacteria (PPM) and restore a deranged barrier function. It is therefore of interest to test if these abilities of probiotics can be utilized in preoperative prophylaxis. These factors may be corrected by perioperative administration of probiotics in addition to antibiotics. Fourteen randomized clinical trials have been presented in which the effect of such regimens has been tested. It seems that in patients undergoing liver transplantation or elective surgery in the upper gastrointestinal tract prophylactic administration of different probiotic strains in combination with different fibers results in a three-fold reduction in postoperative infections. In parallel there seems to be a reduction in postoperative inflammation, although that has not been studied in a systematic way. The use of similar concepts in colorectal surgery has not been successful in reducing postoperative infections. Reasons for this difference are not obvious. It may be that higher doses of probiotics with longer duration are needed to influence microbiota in the lower gastrointestinal tract or that immune function in colorectal patients may not be as important as in transplantation or surgery in the upper gastrointestinal tract. The favorable results for the use of prophylactic probiotics in some settings warrant further controlled studies to elucidate potential mechanisms, impact on gut microbiota and influence on clinical management. The use of probiotics must be better delineated in relation to type of bacteria, dose and length of administration.

Antibiotic Prophylaxis in Septorhinoplasty? A Prospective, Randomized Study

The routine use of antibiotics in septorhinoplasty is widespread and recommended in many textbooks despite the lack of scientific evidence for their use. This practice has led to extensive discussions in the face of the emerging threat of antibiotic resistance and rising health care costs. The aim of our study was to investigate the role of antibiotic prophylaxis in septorhinoplasty. The authors conducted a prospective, randomized, single-blind study at a tertiary referral center in a private practice setting, including 200 patients undergoing septorhinoplasty over a 4-year period. One hundred patients received preoperative single-shot antibiotics, and the other 100 received a combined regimen with preoperative single-shot antibiotics plus a postoperative 7-day course of oral antibiotics. Three patients (3 percent) developed postoperative local wound infections in the group with combined treatment; no infections occurred in the group treated with the preoperative single intravenous dose at induction alone, and the difference was not statistically significant. The rate of common antibiotic-induced side effects (e.g., nausea, diarrhea, skin rashes, pruritus) was significantly higher in the combined treatment group (29 percent versus 2 percent, p = 0.03). The cost for antibiotics and medication to treat the side effects per patient was significantly higher in the combined treatment group (93.45 AUD versus 14.50 AUD, p= 0.04). The authors' results would suggest that a single dose of antibiotics administered preoperatively in endonasal septorhinoplasty with autologous cartilage grafting is sufficient for prophylaxis of postoperative infections, thus eliminating the costs for postoperative antibiotics and the management of their side effects.

Recovery of the Susceptibility of Isolated Bacterium Achieved by Giving Long-Established Antibiotics as Prophylaxis Against Postoperative Infections

To evaluate the effectiveness of operative antibiotic therapy we changed the antibiotics and examined the susceptibility of the postoperative infection. We studied 4 593 patients who underwent gastrointestinal surgery during the last 12.5 years, and examined the changes in intraoperative antibiotics, the return of bacteria isolated from infectious sites, the trends in frequency of Methicillin-resistant Staphylococcus aureus (MRSA) isolation, and changes in the antibiotic susceptibility of Pseudomonas aeruginosa and Bacterioides fragilis. We changed the antibiotics to Cefazolin (CEZ) for upper gastrointestinal tract surgery and cholecystectomy, and to Cefotiam (CTM) for colonic, liver, and pancreatic surgery. We also reduced the period of drug administration. The rate of MRSA infections decreased, the rate of P. aeruginosa infections was always under 20% and the rate of B. fragilis infections increased. After the guidelines of drug susceptibility were prepared, the minimum inhibitory concentrations (MICs) of Cefsulodin (CFS) and Piperacillin (PIPC) for P. aeruginosa and of Latamoxef (LMOX) and PIPC for B. fragilis, decreased. The use of antibiotics considered comparatively old for the prophylaxis of postoperative infection prevented the emergence of MRSA-like resistant strains, influenced changes in Gram-negative bacteria drug susceptibility, and led to an overall reduction in multiple drug resistance.

Immunonutrition (IMN) for prophylaxis of postoperative infections in major surgery

Immunonutrition (IMN) for prophylaxis of postoperative infections in major surgery

Surgical prophylaxis in practice

The use of antibacterial prophylaxis of postoperative infections is firmly established within clean-contaminated procedures. For clean procedures, prophylaxis has traditionally been reserved for operations involving foreign-body implantation. However, evidence that postoperative infections from non-prosthetic clean procedures are highly under-reported suggests that prophylaxis is also advisable, at least for some non-prosthetic procedures, such as breast surgery and herniorrhaphy. Although cefazolin is recommended by current guidelines, cefuroxime and cefamandole have a broader antimicrobial spectrum and should be preferred in clean prosthetic surgery prophylaxis. In this type of surgery glycopeptides are not recommended for routine use but may have a role for major prosthetic implantation in units with a high incidence of methicillin-resistant staphylococci. In the case of clean-contaminated procedures, cefazolin is recommended for routine use, although colorectal procedures require an agent with improved anti-anaerobic activity. In addition, experience has shown that obstetric/gynaecological, gastroduodenal and biliary tract surgery and appendectomy all require broad-spectrum antibacterial prophylaxis. Suitable agents include cefoxitin, cefotetan, ureidopenicillins and beta-lactam/beta-lactamase inhibitor combinations. The traditional surgical classification scheme needs to be replaced with a classification that additionally accounts for patient-specific risk factors. The limitations of the current scheme may partly explain why current guidelines are so seldom followed in clinical practice.

Microencapsulation of gentamicin in biodegradable PLA and/or PLA/PEG copolymer

Biodegradable carriers containing gentamicin for local treatment of bone infection were developed. This paper describes the preparation and in vitro evaluation of these biodegradable implants. Poly-l-lactic acid (PLA) and polyl-lactic acid/polyethylene glycol (PLA/PEG) disk implants containing gentamicin sulphate were obtained by compression of microspheres prepared by a double emulsion process. The mean particle size distribution of the microspheres, based on volume, ranged from 95-270 µm. The gentamicin sulphate loading of the microspheres, after a methylene chloride-water extraction procedure, exceeded 90% of the theoretical value. In vitro dissolution studies on the microspheres and implants with drug loadings 10-40% w/w indicated that the rate of drug release from both PLA and PLA/PEG implants increased, with an increase in drug loading. The release of gentamicin from microspheres was dependent on the properties of PLA and/or PLA/PEG. The PLA/PEG copolymer was more hydrophilic than the PLA homopolymer, and with a smaller pH change in the microenvironment with polymer being degraded. In comparison, the PLA/PEG implant released antibiotic faster and had a larger inhibitory zone based on the Bauer-Kirby experiments used to test the inhibitory activity of antimicrobial devices. Experimental results showed that the biodegradable PLA/PEG gentamicin delivery system had a potential for prophylaxis of post-operative infection.

A questionnaire survey on the theory of postoperative infection prophylaxis in gynecology

A questionnaire survey on the theory of postoperative infection prophylaxis was conducted to obtain the consensus on perioperative antimicrobial use among gynecologists in Japan in the period from April to July 2000. Fifty-six of the 83 gynecologists replied, and the following consensus was obtained. An antimicrobial prophylaxis (AMP) agent should be chosen based on their efficacy against the pathogens expected to be contaminants, such as Staphylococcus spp., Escherichia coli and Bacteroides fragilis group. Use an AMP agent that archives a bactericidal concentrations in both the serum and operating site. Use an AMP agent that has little unfavourable side effects. The newer agents should be considered as a therapeutics for postoperative infections. The therapeutic antimicrobial agents having no cross-resistance to the AMP agents should be used, if postoperative infection is suspected or developed. The most commonly used agent for clean operations are cefazolin (CEZ), followed by cefotiam (CTM) and cefmetazole (CMZ). The most commonly used agent for clean-contaminated operations where low grade level of bacterial invasion expected is CTM, followed by CEZ and CMZ, where as operations where mild grade level of bacterial invasion expected is flomxef (FMOX), followed by CTM and other cephalosporins.

A questionnaire survey on the theory of postoperative infection prophylaxis in orthopedics

A questionnaire survey on the theory of postoperative infection prophylaxis was conducted to obtain the consensus on perioperative antimicrobial use among orthopedists in Japan in the period from April to September 2000. Fifty of the 91 orthopedists replied, and the following consensus was obtained. An antimicrobial prophylaxis (AMP) agent should be chosen based on their efficacy against the pathogens expected to be contaminants, such as Staphylococcus spp., and Streptococcus spp., Use an AMP agent that achieves a bactericidal concentration in both the serum and operating site. Use an AMP agent that has little unfavourable side effects. Use an AMP agent that affects minimally the normal bacterial flora. The most commonly used agents are the penicillins and first and second generation cephalosporins. The optimal strategy for most commonly used agents entails infusion of the first dose between approximately 30 minutes pre and post-skin incision and the therapeutic levels should be maintained throughout the operation. The AMP agents having no cross-resistance to the prophylactic agents should be used, if postoperative infection is suspected or developed. The most commonly used agent for both clean operations with or without foreign implants and dirty operations is cefazolin (CEZ), followed by cefotiam (CTM) and flomoxef (FMOX).

Comparison of ceftibuten vs. amoxicillin/clavulanic acid as antibiotic prophylaxis in cholecystectomy and/or biliary tract surgery

A randomized, comparative, prospective clinical trial was carried out a tertiary care center to compare the efficacy of two antibiotic regimens in the prophylaxis of postoperative infection in patients undergoing biliary tract surgery. One hundred patients undergoing cholecystectomy or biliary tract exploration were randomly allocated to one of the following antibiotic regimens: the standard regimen of three doses of amoxicillin/clavulanic acid (1000/200 mg) given by intravenous infusion, or a single dose of ceftibuten (400 mg) given orally. Patients were monitored during their stay in the hospital and over a 2 week period as outpatients. Fifty adult patients were included in each group. Mean age was 49 years, and sex distribution was 82 women and 18 men. The groups were comparable in terms of demographic characteristics and comorbidity. There were no cases of postoperative infection in the ceftibuten group, but five cases of infection occurred in the amoxicillin/clavulanic acid group ( P <0.05). No adverse effects were observed with either antibiotic. The treatment of cost per patient was significantly lower for ceftibuten. The results indicate that ceftibuten is well tolerated and more effective than amoxicillin/clavulanic acid for prophylaxis following gallbladder and biliary tract surgery. In addition, ceftibuten has the advantage of being more cost-effective and easier to administer than amoxicillin/clavulanic acid so it could be considered as an alternative for antibiotic prophylaxis in these types of surgical procedures.