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Short-term antibiotic prophylaxis of mixed infections during hysterectomy
Abstract:
Surgical procedures on contaminated tissues, such as hysterectomy with opened vagina, are frequently followed by local or systemic infections. It seems that a prolonged antibiotic prophylaxis is not justified because of possible induction of resistant mutants or dysmicrobisms. The administration of antibiotics only in a short pre- and postsurgical period appears to be more rational. We have carried out a controlled clinical trial with the aim of evaluating the efficacy of this prophylactic practice. One hundred forty-five patients submitted to vaginal and two hundred seventy-five to abdominal hysterectomy entered this study (started September 1977). All patients received local nitrofurantoin treatment and were then subdivided into four randomized groups: control group, groups treated with thiamphenicol, cephazolin, thiamphenicol plus cephazolin, respectively. Each antibiotic was administered in the dose of 1 gm one hour before and five and 12 hours after surgery. Antibiotics were chosen taking into consideration the usual vaginal microbial flora, notoriously mixed (aerobic and anaerobic). The three treated groups presented a significant decrease in the incidence and severity of infectious complications. The use of antibiotics in the postoperative period resulted in significantly reduced morbidity in the treated groups. Thiamphenicol appears to be the most effective drug. Bacteriological studies showed that local treatment of the vagina decreased the bacteria charge, but never brought about sterilization.
Insights
Short-term antibiotic prophylaxis, including thiamphenicol, cephazolin, or both, significantly reduced infectious complications following hysterectomy. Thiamphenicol demonstrated the greatest efficacy in preventing postoperative morbidity.
Area of Science:
- Infectious Diseases
- Surgical Prophylaxis
- Pharmacology
Background:
- Hysterectomy procedures, particularly those involving contaminated tissues, often lead to post-operative infections.
- Prolonged antibiotic prophylaxis may induce resistant microbial strains and dysbiosis, making shorter regimens more rational.
Purpose of the Study:
- To evaluate the efficacy of short-term antibiotic prophylaxis in reducing infectious complications after hysterectomy.
- To compare the effectiveness of thiamphenicol, cephazolin, and a combination therapy against local nitrofurantoin treatment.
Main Methods:
- A controlled clinical trial involving 420 patients undergoing vaginal or abdominal hysterectomy.
- Patients received local nitrofurantoin followed by randomization into four groups: control, thiamphenicol, cephazolin, or combined therapy.
- Antibiotics were administered perioperatively (1 hour pre-surgery, 5 and 12 hours post-surgery).
Main Results:
- All three antibiotic treatment groups showed a significant reduction in the incidence and severity of infectious complications compared to the control.
- Postoperative antibiotic administration led to significantly reduced morbidity in the treated groups.
- Thiamphenicol was identified as the most effective single agent in this prophylactic regimen.
Conclusions:
- Short-term, perioperative antibiotic prophylaxis is an effective strategy for preventing infections after hysterectomy.
- The combination of local vaginal treatment with systemic antibiotics offers a rational approach to managing surgical site infections.
- Thiamphenicol shows promising efficacy as a prophylactic agent in this context.