[Antibiotic prophylaxis for high risk patients undergoing cholecystectomy]

Area of Science:

• Surgical Infections
• Pharmacology
• Clinical Trials

Background:

• Open cholecystectomy is a common surgical procedure.
• High-risk patients are susceptible to infectious complications.
• Antibiotic prophylaxis is standard practice in biliary surgery.

Purpose of the Study:

• To evaluate the efficacy of amoxicillin/clavulanic acid versus other antibiotics for prophylaxis in high-risk open cholecystectomy patients.
• To determine optimal antibiotic prophylaxis strategies for preventing surgical site infections.

Main Methods:

• An open, randomized clinical trial involving 435 high-risk patients.
• Three groups: amoxicillin/clavulanic acid, comparator antibiotics, and no prophylaxis (control).
• Analysis using Student t-test and chi-squared methods; antibiotic concentrations measured in serum and bile.

Main Results:

• Wound infection rate was 2.76% with amoxicillin/clavulanic acid vs. 5.48% with comparator antibiotics.
• The difference was significant in patients >65 years or with >5 days preoperative hospitalization.
• Amoxicillin/clavulanic acid levels exceeded therapeutic concentrations in serum and major bile duct bile.

Conclusions:

• Systemic antibiotic prophylaxis is essential for high-risk patients undergoing open cholecystectomy.
• Amoxicillin/clavulanic acid appears to be an effective prophylactic agent.
• Further research may optimize antibiotic selection based on patient risk factors and drug concentrations.