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Perioperative antibiotic prophylaxis in general thoracic surgery.
H Wertzel1, L Swoboda, A Joos-Würtemberger
1Department of Pulmonary Surgery, University Hospital, Freiburg, Germany.
The Thoracic and Cardiovascular Surgeon
|December 1, 1992
Summary
Ampicillin and sulbactam (A/S) effectively prevented infections in lung surgery patients. A single dose showed comparable results to multiple doses, suggesting A/S is a viable perioperative prophylactic option.
Area of Science:
- Thoracic Surgery
- Infectious Disease
- Pharmacology
Background:
- Perioperative infections pose a significant risk in thoracic surgery.
- Beta-lactamase inhibitors are crucial for combating bacterial resistance.
- Ampicillin in combination with sulbactam (A/S) is a potential prophylactic agent.
Purpose of the Study:
- To evaluate the efficacy of ampicillin in combination with sulbactam (A/S) for perioperative prophylaxis in lung surgery.
- To compare different dosing regimens of A/S.
- To assess drug concentrations in serum and lung tissue.
Main Methods:
- Prospective study with two parts.
- Part I: 60 patients undergoing lobectomies/segmentectomies, comparing single-dose A/S vs. multi-dose A/S.
- Part II: 25 pneumonectomy patients receiving multi-dose A/S, with pharmacokinetic analysis.
Main Results:
- In Part I, infection rates were low and similar between single-dose (3/60 superficial wound infections) and multi-dose (2/60 superficial wound infections) A/S groups.
- No empyema occurred in Part I.
- In Part II, pharmacokinetic analysis showed adequate ampicillin and sulbactam levels; low incidence of superficial wound infections (1/25) and respiratory infections (4/25) was observed.
Conclusions:
- Ampicillin in combination with sulbactam (A/S) demonstrates efficacy as perioperative prophylaxis in lung surgery.
- A single prophylactic dose of A/S appears as effective as multiple doses.
- Adequate drug concentrations support the use of A/S in this patient population.