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Single-dose metronidazole vs 5-day multi-drug antibiotic regimen in excision of pilonidal sinuses with primary
A Chaudhuri1, B A Bekdash, A L Taylor
1Department of General Surgery, Hinchingbrooke Hospital, Huntingdon, PE29 6NT, UK. a.chaudhuri@tiscali.co.uk
Aim:
To compare infection-related wound complications following excision of pilonidal sinuses with primary closure using either single-dose intravenous (i.v.) administration of metronidazole preoperatively or a broad-spectrum multi-drug regimen.
Patients And Methods:
This is a double-blinded study wherein 50 patients were randomized into receiving either single-drug (metronidazole 500 mg i.v.) prophylaxis preoperatively or multi-drug cover (cefuroxime 1.5 g i.v. and metronidazole 0.5 g i.v. preoperatively, and co-amoxiclav 375 mg orally 8-hourly postoperatively for 5 days). They were reviewed at 1, 2 and 4 weeks postoperatively. Wounds were graded as follows: I, healthy; II, redness and swelling of edges; III, abscess in relation to a suture; IV, spreading wound infection; and V, wound breakdown. Other factors considered were the distance from the lowest wound margin to the anal verge and previous local surgery.
Results:
Fifty patients (38 men and 12 women, mean age 27 years) underwent pilonidal sinus surgery. At week 1, there was no difference in wound infection rates (p=0.9). However, there were significantly more wound infections in the single-drug group at week 2 (p<0.0001) and week 4 (p=0.03). Seventy-two per cent of all patients had complete wound healing at week 4. Distance from the anal verge and previous surgery did not affect wound infection rates (p> or =0.2). Treating such complications costs 73,219.20 dollars per 100 patients.
Conclusion:
A broad-spectrum 5-day regimen is superior to 'single-shot' antibiotic prophylaxis in preventing infection-related wound complications. However, this study needs to be conducted in a larger number of patients to have statistical power.
Insights
A 5-day broad-spectrum antibiotic regimen significantly reduces infection-related wound complications after pilonidal sinus surgery compared to single-dose metronidazole. This finding highlights the importance of comprehensive antibiotic prophylaxis for better surgical outcomes.
Area of Science:
- Surgical infection control
- Antibiotic prophylaxis efficacy
- Pilonidal sinus disease management
Background:
- Pilonidal sinus excision with primary closure can lead to infection-related wound complications.
- Current prophylactic antibiotic strategies vary, with single-dose regimens being common.
Purpose of the Study:
- To compare the effectiveness of single-dose intravenous metronidazole versus a 5-day broad-spectrum multi-drug regimen in preventing wound infections after pilonidal sinus surgery.
- To evaluate the impact of antibiotic choice on postoperative wound healing and complication rates.
Main Methods:
- A double-blinded study randomized 50 patients undergoing pilonidal sinus excision and primary closure.
- Group 1 received single-dose intravenous metronidazole; Group 2 received a multi-drug regimen (intravenous cefuroxime and metronidazole preoperatively, oral co-amoxiclav postoperatively for 5 days).
- Wound complications were graded and assessed at 1, 2, and 4 weeks postoperatively; factors like anal verge distance and prior surgery were also considered.
Main Results:
- While no difference was observed at week 1, the multi-drug regimen group showed significantly fewer wound infections at weeks 2 (p<0.0001) and 4 (p=0.03).
- Overall, 72% of patients achieved complete wound healing by week 4.
- Neither distance to the anal verge nor previous surgery influenced infection rates (p>=0.2).
Conclusions:
- A 5-day broad-spectrum antibiotic regimen is superior to single-shot prophylaxis in preventing infection-related wound complications following pilonidal sinus surgery.
- The study suggests a need for larger trials to confirm these findings and establish definitive guidelines.