Single-dose Antibiotic Prophylaxis Research Articles

Single-Dose Antibiotic Prophylaxis in Transurethral Resection of the Prostate: A Prospective Randomized Trial

Objective To evaluate the efficacy of single-dose antibiotic prophylaxis in transurethral resection of the prostate (TURP). Patients and methods A total of 139 patients were entered into a prospective randomized trial comparing single-dose antibiotic prophylaxis with no antibiotic before surgery. Twelve patients were excluded because they had significant bacteriuria before surgery (defined as ≥105 bacteria/mL). Of the remaining 127 patients, 62 were allocated to the single-dose group (A) and 65 to the no-antibiotic group (B). All 62 patients in group A received 1 g of ceftriaxone intravenously 1–2 h before surgery with the anaesthetic premedication, the 65 in group B receiving none. Urine cultures were collected post-operatively as the catheter was removed and again 4 weeks after hospitalization. Results The incidence of post-operative bacteriuria was statistically significantly different, occurring in five patients (9%) in group A and 16 patients (26%) in group B (Fisher’s exact test, one-tail P=0.009). There was no significant difference between the groups 4 weeks after hospitalization. The overall incidence of bacteriuria post-operatively and 4 weeks after hospitalization was 11 patients (18%) in group A and 22 patients (34%) in group B (P=0.03). Conclusion Single-dose antibiotic prophylaxis with 1 g of ceftriaxone intravenously is effective in patients undergoing TURP and is recommended for such surgery.

Single-dose antibiotic prophylaxis during cesarean section

Objective: To compare single-dose antibiotic prophylaxis (cefotetan 1 g vs cefoxitin 2 g) in various subpopulations based upon risk factors for postsurgical infection following cesarean section. Methods: Patients undergoing cesarean section from April 1993 through March 1994 were included in a retrospective analysis if either of the above antibiotics were administered, surgery was non-emergent, gestational age was less than 32 weeks, absence of fever or prior antibiotics therapy within 72 hours, and no history of organ transplantation or HIV. Cases classified as high risk for infection: IDDM, obesity, autoimmune disease, sickle cell disease, or corticosteroid use. Cases classified as high risk for endometritis (any 2 factors): labor >12 hours, >4 vaginal examinations, ruptured membranes >9 hours, and internal fetal monitor. Cases were separated into 4 groups: elective vs non-elective, low vs high surgical risk. A χ 2 analysis was used to test for differences in infection rates between groups ( P < .05). Results: Of 1383 cesarean sections, 385 met criteria for inclusion. Non-elective cases accounted for 77% of cases. Postsurgical infection rate was greater in non-elective cases, 7.4%, vs elective cases, 3.0% ( P = .056) as was the rate of endometritis (3.2% vs 1.2%, P = .185). No differences were noted based on antibiotic regimen. Postsurgical infection rate was greater for 28 cases at high risk for both surgical infection and endometritis (17.9%) when compared to all 357 other cases (4.5%), P = .003. No difference was noted for endometritis. Of the 28 cases 28.6% of patients treated with cefoxitin and 7.1% of cases treated with cefotetan developed postsurgical infection ( P = .13). Conclusion: Overall cefoxitin and cefotetan provided equivalent clinical outcome. A small subset of patients with multiple risk factors for infection may benefit from cefotetan.

Incidence of Postpartum Endomyometritis Following Single-Dose Antibiotic Prophylaxis With Either Ampicillin/Sulbactam, Cefazolin, or Cefotetan in High-Risk Cesarean Section Patients

Objective To assess the efficacy of single-dose antibiotic prophylaxis against postpartum endomyometritis in high-risk cesarean section patients. Design Patients were administered one of three single-dose antibiotic regimens following umbilical cord clamping after cesarean section delivery. Setting Prospective randomized trial at a university-based hospital. Patients The study evaluated 293 consenting women undergoing cesarean section who had either experienced labor for a duration of 6 hr or rupture of amniotic membranes. Main outcome measures Development of postpartum endomyometritis. Results The incidence of postpartum endomyometritis was 7/95 (7.4%) following the ampicillin/sulbactam regimen, 14/98 (14.3%) after the cefazolin regimen, and 11/99 (11.1%) after the cefotetan regimen. There was no significant difference in postpartum infection among the three study arms. In addition, the incidence of endomyometritis in the three single-dose study arms was not higher than previously noted in studies where three doses of antibiotic were administered. Conclusion Single-dose antibiotic prophylaxis should replace the standard triple-dose therapy for uninfected women undergoing cesarean section who are at risk for postoperative endomyometritis. Ampicillin/sulbactam, cefazolin, and cefotetan are all reasonable antibiotic choices for single-dose therapy. Infect. Dis. Obstet. Gynecol. 6:220–223, 1998. © 1998 Wiley-Liss, Inc.

Is single-dose antibiotic prophylaxis sufficient for coronary artery bypass surgery? An analysis of peri- and postoperative serum cefuroxime and vancomycin levels

Preliminary findings have suggested that a single intravenous dose of antibiotic is effective for infection prophylaxis in cardiac surgery. However there are still insufficient data on this proposed regimen. We measured serum cefuroxime and vancomycin levels after three different dosage regimens, in patients undergoing coronary artery bypass grafting (CABG). Sixty patients were randomized into three cefuroxime and three vancomycin groups with 10 patients in each: a group given a one-day course, or an additional dose during cardiopulmonary bypass or a single dose. Serum levels of the antibiotics were measured at various times throughout the operative procedure and until 48 h after the start of prophylaxis. Each of the six dosage regimens maintained serum levels adequate for infection prophylaxis throughout the operative procedure. Serum levels remained above 2 mg/L for more than 8 h postoperatively, even in the single-dose cefuroxime group and above 4 mg/L for more than 24 h with all the vancomycin dosage regimens. Thus a single dose of cefuroxime (3 g or 1·5 g) or vancomycin (1·5 g) seems to achieve and maintain serum levels sufficient for infection prophylaxis several hours after CABG procedures.

Randomised controlled trial of single-dose antibiotic prophylaxis in surgical treatment of closed fractures: the Dutch Trauma Trial

SummaryBackground The efficacy of prophylactic antibiotics in fracture surgery remains controversial for lack of well-documented prospective studies. We report here the findings of the Dutch Trauma Trial, a prospective, randomised, double-blind, placebo-controlled study of antibiotic prophylaxis in the primary operative treatment of limb fractures. Ceftriaxone was chosen because of its broad spectrum of activity and because its pharmacokinetic profile, including high serum levels, high tissue penetration, and long elimination half-life, makes it suitable for single-dose prophylaxis.Methods Patients aged 18 years or more, attending one of fourteen Dutch centres for acute treatment of closed fractures, were randomly allocated to a single preoperative dose of ceftriaxone 2 g or placebo, and evaluated for development of wound infection and nosocomial infection at 10 days, 30 days, and 120 days. To assess the effects of drop-outs and withdrawals, best-case and worst-case analyses were performed.Findings A total of 2195 patients were included. The incidence of superficial and deep wound infections after placebo was 8·3%, compared with 3·6% in the ceftriaxone group (p<0·001, Pearson X2-test). The rate of nosocomial infection in the first month was 10·2% with placebo and 2·3% with ceftriaxone (p<0·001, Pearson χ2-test). Gram-positive bacteria were found in 74·5% of wound infections and 13·4% of nosocomial infections.Interpretation Adequate single-dose prophylaxis with a long-acting broad-spectrum antibiotic substantially reduces the incidence of wound infection and early nosocomial infection after surgery for closed fractures.

Antibiotic prophylaxis in cerebrospinal fluid shunting: a prospective randomized trial in 129 patients

The efficacy of a single dose of cefotiam, a cephalosporin of the second generation, as prophylaxis for postoperative infection was analyzed in a prospective randomized study of 129 patients undergoing cerebrospinal fluid shunting. The main focus of interest was the rate of shunt infection requiring operative shunt removal. Data were evaluated in the total group and subgroups formed for normal and high risk patients, respectively. The overall rate of shunt infection was 7.5% in the cefotiam group and 12.9% in the control group. In the high risk subgroup infection rate was 14.3% with and 26.3% without cefotiam as opposed to 4.3% and 6.9%, respectively, in the normal risk subgroup. Although our results do not reach statistical significance, there is a noticeable difference of infection rate between those patients who receive the antibiotic and those who do not. Therefore, we favor single dose antibiotic prophylaxis in shunting procedures.

Prospective randomised comparison of single-dose versus multiple-dose cefuroxime for prophylaxis in coronary artery bypass grafting

To assess the efficacy of single-dose antibiotic prophylaxis in coronary artery bypass grafting, 1,016 consecutive patients were prospectively randomized to receive either a single dose or a three-day course of cefuroxime. Nine patients (0.9%) died within seven days; no death was caused by infection. For various reasons 163 other patients were not evaluable. Therefore, 844 patients were evaluated. Patients in group A (n = 419) received 20 mg/kg cefuroxime intravenously at induction of anaesthesia; group B (n = 425) received the same dose followed by 750 mg t.i.d. for three consecutive days. Both groups were comparable regarding all risk factors. The efficacy of the prophylactic regimens was evaluated by comparison of occurrence of wound infection in both groups. No significant differences in wound infection were observed between the two treatment groups: sternal site infection in the single-dose prophylaxis group was 14% versus 13% in the three-day course group; donor site infection occurred in 38% versus 39%. It is concluded that in coronary artery bypass grafting a single dose of cefuroxime is as effective as a three-day course in the prevention of wound infection.

Randomized Controlled Study of Chemoprophylaxis in Transurethral Prostatectomy

We studied 599 evaluable patients with benign prostatic hypertrophy at 7 urological units. Before transurethral prostatectomy the patients were randomized into 3 groups: group 1—197 patients given single-dose ceftriaxone (2 gm.), group 2—203 patients given 160/800mg. trimethoprim-sulfamethoxazole and group 3—199 controls given no antimicrobial prophylaxis. Patients with a preoperative indwelling catheter, positive urine culture, signs of active infection or preoperative antibiotic treatment were excluded. Postoperative infectious complications were demonstrated in 15 of 197 (7.6%), 25 of 203 (12.3%) and 43 of 199 (21.6%) patients in the study groups, respectively. The difference in infectious complications between groups 1 and 3 was statistically highly significant (p <0.01) and between groups 2 and 3 it was significant (p <0.05). Single-dose antibiotic prophylaxis proved to be useful in the prevention of serious infectious complications after transurethral prostatectomy.

Single-dose antibiotic prophylaxis with teicoplanin in cancer patients receiving continuous infusion interleukin-2 through central venous catheter

Single-dose antibiotic prophylaxis with teicoplanin in cancer patients receiving continuous infusion interleukin-2 through central venous catheter

Comparison of Single-Dose Antibiotic Prophylaxis in Uncomplicated Transurethral Resection of the Prostate

We evaluated the necessity for antibiotic prophylaxis in uncomplicated transurethral resection of the prostate. A total of 107 patients was entered into a double-blind, prospective, placebo-controlled, randomized trial. Only 7 patients were excluded because they had positive preoperative urine cultures. All patients received a single dose of either 1gm. cefonicid or saline placebo intramuscularly before surgery. No further antibiotics were administered. Urine cultures were obtained intraoperatively, daily while hospitalized, and at 2 and 4 weeks postoperatively. A growth of 104 organisms constituted a positive urine culture. Postoperative infection rates were statistically significant with 12% (6 of 51) in the cefonicid group and 37% (18 of 49) in the placebo group (p = 0.003). During the initial 2 days postoperatively there were no infections in the cefonicid treated patients as opposed to 8 in the placebo group (p = 0.003). Our study demonstrated the need for antibiotic prophylaxis to prevent infection after uncomplicated transurethral resection of the prostate. This can be accomplished by using a single dose, broad-spectrum cephalosporin (cefonicid). This procedure simplifies the implementation and decreases the cost of prophylaxis for transurethral resection of the prostate.

Cefonicid versus clindamycin prophylaxis for head and neck surgery in a randomized, double-blind trial, with pharmacokinetic implications

Perioperative single-dose antibiotic prophylaxis of cefonicid was compared with clindamycin in a prospective, randomized, double-blind trial of patients undergoing oncologic head and neck surgery. Antibiotics were administered intravenously beginning 1 to 2 h preoperatively. Cefonicid, 1 g, was given as a single dose. Clindamycin, 600 mg, was administered every 8 h for a total of four doses. Blood and wound drainage samples were collected for 24 h following the dose of cefonicid and assayed for total and free cefonicid concentrations, using reverse-phase high-performance liquid chromatography. Although total concentrations of cefonicid in both serum and wound drainage exceeded the MIC for 90% of the isolates of common bacterial pathogens for 24 h, free concentrations in serum and wound drainage (11.0 and 14.9% of total concentrations) were subinhibitory within 6 h following administration. Free concentrations of cefonicid in the postoperative wound drainage were subinhibitory for the entire study period, both perioperatively and postoperatively. Postoperative wound infection occurred significantly (P less than 0.05) more frequently in patients receiving cefonicid (24%) as compared with those receiving clindamycin (8.2%). The relatively low free levels of cefonicid achieved in serum and wound drainage were attributed to the high degree of protein binding (89% in serum) and may be related to the poor clinical outcome.

Prospective study of Clostridium difficile intestinal colonization and disease following single-dose antibiotic prophylaxis in surgery

A total of 108 volunteers undergoing an elective surgical procedure were randomly given a single 2-g intravenous prophylactic dose of either a cephalosporin or mezlocillin. Stool samples were cultured for Clostridium difficile the day before the operation and later on postoperative days 4, 7, and 14. C. difficile was detected in 23.0% of patients who received a cephalosporin (cefoxitin, 8.3%; cefazolin, 14.3%; cefotetan, 20.0%; ceftriaxone, 25.0%; cefoperazone, 43.7%), in 3.3% of patients given mezlocillin, and in none of 15 control volunteers given no antimicrobial agent. No patient experienced diarrhea.

Vaginal hysterectomy: cefuroxime, metronidazole or both?

A randomized double-blind prospective study on the efficacy of single-dose antibiotic prophylaxis compared cefuroxime versus metronidazole versus the combination of both agents in vaginal hysterectomy. Overall antibiotic prophylaxis was effective in abscess prevention (one abscess in 68 patients). In the metronidazole group a significantly higher grade of morbidity was observed: febrile morbidity 41% versus 4% in the two other groups; bacteriuria 73% versus 17% in the cefuroxime group, versus 13% in the combined group; urinary tract infection 23%, versus 0% in the two other groups; post-operative prescription of antibiotics 41%, versus 0% in the two other groups. Febrile morbidity and bacteriuria correlated positively with Escherichia coli and Proteus spp. These micro-organisms were recovered significantly more often from the vagina of patients in the metronidazole group. Cefuroxime was successful, metronidazole failed in the prevention of minor morbidity. We could not observe any effect from the addition of metronidazole to the cefuroxime prophylaxis.

Ciprofloxacin as single-dose antibiotic prophylaxis in colorectal surgery results of a randomized, double-blind trial

Ciprofloxacin as single-dose antibiotic prophylaxis in colorectal surgery results of a randomized, double-blind trial

Single-dose antibiotic prophylaxis for patients undergoing extended pelvic surgery for gynecologic malignancy

The comparative efficacy of single-dose antibiotic prophylaxis was retrospectively evaluated in 116 patients undergoing extended pelvic surgical procedures with curative intent. During the 24-month period, other important variables such as surgeon's experience, duration of preoperative hospitalization, preoperative preparation, method of hair removal, suture type, suture size, use of drains, use of cautery, and abdominal closure were controlled. The overall surgical site infection rate was 4.3% after radical hysterectomy with lymphadenectomy and 4.5% after total hysterectomy with lymphadenectomy. In this clinical situation the use of a single dose of antibiotic prophylaxis theoretically decreases cost and patient exposure and appears to be as efficacious as a multiple-dose regimen.

Single-Dose Antibiotic Prophylaxis in Elective Colorectal Surgery

In a randomized controlled trial single-dose peroperative intravenous mezlocillin, 5 g (group 1, n = 51), was compared with single-dose mezlocillin, 5 g, and metronidazole, 500 mg (group 2, n = 58), i

Single dose antibiotic prophylaxis for patients treated with extended hysterectomy for gynecologic malignancy

Single dose antibiotic prophylaxis for patients treated with extended hysterectomy for gynecologic malignancy

Use of a long-acting cephalosporin (ceftriaxone) for antimicrobial prophylaxis in abdominal and biliary surgery.

Present data available on ceftriaxone (Rocephin) dealing with microbiology, pharmacokinetics (long half-life, tissue penetration ability, tissue concentration present during vulnerable period, etc.), results of clinical trials, and world-wide experience seem to be in favor of ceftriaxone as the antimicrobial of choice for single-dose antibiotic prophylaxis in abdominal and biliary surgery. Single-dose surgical prophylaxis is cost-effective, has a low rate of adverse drug events, and so far does not increase danger of resistance.

Single-Dose Antibiotic Prophylaxis of Abdominal Surgical Wound Infection: A Trial of Preoperative Latamoxef against Peroperative Tetracycline Lavage

A randomized controlled clinical trial was undertaken in 542 consecutive emergency and elective abdominal operations, with one group of patients receiving tetracycline peritoneal and wound lavage and the other a single intravenous injection of 1 g latamoxef at induction of anaesthesia. Seventy-five patients were withdrawn because no potentially contaminated hollow viscus was opened, and a further 36 because they could not be assessed for wound infection. Of the remaining 431 patients, 212 received latamoxef resulting in 5 major and 8 minor wound infections in hospital; another 4 minor infections occurred at home (total incidence 8.0%). In the tetracycline group (n = 219) there were 7 major and 19 minor wound infections in hospital and 10 minor infections later (total incidence 16.4%). This is significantly higher than the rate with latamoxef (P = 0.012). Monitoring of operative and postoperative bleeding revealed no evidence (except in one doubtful case) of excessive bleeding associated with the use of a single dose of latamoxef. It is concluded that single-dose preoperative latamoxef is more effective than peroperative tetracycline lavage for the prevention of wound infections after potentially contaminated abdominal operations.

Biliary excretion and tissue levels of cefuroxime

A study of levels of cefuroxime in blood, liver, gall bladder wall, gall bladder bile, bile from the common bile duct, muscle and skin of patients undergoing cholecystectomy after a single intravenous dose of 750 mg of cefuroxime sodium given at the time of induction of anaesthesia is reported. Levels in bile varied widely and were generally low in samples from diseased gall bladders (mean 4.8 mg/l) but higher levels (mean 9.0 mg/l) were detected in samples from the unobstructed common bile duct. Tissue levels were lower than blood levels, but those in muscle and skin (mean 9.4 mg/kg) would be sufficient to exert a useful antibacterial effect. It is suggested that blood and tissue levels may be more important than bile levels in the prophylaxis of post-operative wound infection, but this and the use of preoperative single dose antibiotic prophylaxis in surgery deserves further study.