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Single-dose metronidazole versus 5-day multi-drug antibiotic regimen in excision of pilonidal sinuses with primary
1Department of General Surgery, Hinchingbrooke Hospital, Huntingdon, UK. arindam@chaudhuri.freeserve.co.uk
Background And Aims:
This pilot study examines whether single-dose intravenous metronidazole preoperatively is at least as effective as a broad-spectrum multi-drug regimen in preventing infection-related wound complications following excision of pilonidal sinuses with primary closure.
Patients And Methods:
A double-blinded study with 50 patients randomised to receiving either a single drug (intravenous metronidazole 500 mg) prophylaxis preoperatively or multi-drug cover (intravenous cefuroxime 1.5 g and metronidazole 0.5 g preoperatively, and oral co-amoxiclav 375 mg 8-hourly postoperatively). They will be reviewed 1, 2 and 4 weeks postoperatively. The wound will be graded as: I, healthy; II, redness and swelling of edges; III, abscess related to a suture; IV, spreading wound infection; V, wound breakdown. Other factors considered are the distance from the lowest wound margin to the anal verge, and previous pilonidal sinus surgery.
Results:
Results awaited.
Conclusion:
Single-dose metronidazole seems an appropriate and low-cost antibiotic to consider for prophylaxis in pilonidal sinus surgery. This study will form the base for a trial to be conducted in larger numbers as a randomised controlled trial in order to have statistical power.
Insights
Single-dose intravenous metronidazole may be a cost-effective option for preventing wound infections after pilonidal sinus surgery. This pilot study suggests it is comparable to broader antibiotic regimens, warranting further investigation.
Area of Science:
- Surgical Infection Prevention
- Antibiotic Prophylaxis
- Pilonidal Sinus Surgery
Background:
- Pilonidal sinus excision with primary closure can lead to infection-related wound complications.
- Current multi-drug regimens for prophylaxis are broad-spectrum.
Purpose of the Study:
- To compare single-dose intravenous metronidazole with a multi-drug regimen for preventing wound complications.
- To assess the efficacy and cost-effectiveness of metronidazole prophylaxis.
Main Methods:
- Pilot study with 50 patients randomized to two groups.
- Group 1: Single-dose IV metronidazole.
- Group 2: Multi-drug IV cefuroxime and metronidazole, followed by oral co-amoxiclav.
Main Results:
- Results are currently awaited.
- The study is designed to collect data on wound complication grading at 1, 2, and 4 weeks postoperatively.
Conclusions:
- Single-dose metronidazole appears to be a suitable and economical choice for prophylaxis in pilonidal sinus surgery.
- This pilot study provides a foundation for a larger, statistically powered randomized controlled trial.