[Perioperative single dose prevention with cephalosporins in the ENT area. A prospective randomized study]

Perioperative systemic antibiotic cover is usually recommended in major head and neck surgery with the aim of preventing postoperative wound infection. The surgeon must administer the drug most suitable for the particular operation and patient at an adequate dosage and over an adequate period. On the other hand, he has an obligation to minimize costs and find ways of avoiding the development of bacterial resistance to the antibiotic. This means that prophylactic antibiotics may not have too broad an antibacterial spectrum and may only be used over the short term. In an attempt to improve antibiotic prophylactic in head and neck surgery, we tested the effectiveness of a perioperative single-dose antibiotic cover with cefuroxim (Zinacef) in patients undergoing parotidectomy, sinus surgery or neck dissection with no transcutaneous exploration of the pharynx. This single-shot prophylaxis was compared with a three-shot, 24-hour regimen using the same antibiotic. The two regimens were equally effective in preventing wound infection and no case of infection was observed among the 106 patients involved. Preoperative concentrations of cefuroxim were measured in serum and tissue, and the large majority of specimens showed effective concentrations against the typical wound infection bacteria. In conclusion, a perioperative single-dose administration of cefuroxim proved to be suitable prophylaxis against postoperative wound infection in head and neck surgery.