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Ceftriaxone vs. ampicillin + metronidazole as prophylaxis against infections after clean-contaminated abdominal
M Luke1, J Iversen, J Søndergaard
1Department of Surgery, Sundby Hospital, Copenhagen, Denmark.
Abstract:
In a prospective, controlled, double-blind study, 496 patients undergoing abdominal surgery were given antibiotic prophylaxis with a single dose of either ceftriaxone or ampicillin + metronidazole. No significant intergroup difference was found between the respective overall rates of infectious complications (3.2% and 4.9%). Analysis of the microbiologic findings showed incisional wound infections, mainly caused by gram-negative rods, to be more common in the ampicillin-metronidazole group, whereas deep wound infections were more frequent in the ceftriaxone group. It is concluded that ceftriaxone seems to be more efficient than ampicillin-metronidazole as prophylaxis against incisional wound infection, but should preferably be supplemented with an antianaerobic agent to prevent deep wound infections.
Insights
Ceftriaxone showed better prevention of incisional surgical site infections compared to ampicillin plus metronidazole. However, ceftriaxone may require an antianaerobic agent to prevent deep wound infections.
Area of Science:
- Surgical infection prophylaxis
- Clinical microbiology
- Pharmacology
Background:
- Antibiotic prophylaxis is crucial in preventing surgical site infections (SSIs) after abdominal surgery.
- Choosing the optimal antibiotic regimen balances efficacy against common pathogens and potential resistance.
- Ceftriaxone and ampicillin plus metronidazole are commonly used prophylactic agents.
Purpose of the Study:
- To compare the efficacy of single-dose ceftriaxone versus ampicillin plus metronidazole for antibiotic prophylaxis in patients undergoing abdominal surgery.
- To analyze the microbiological profiles of infectious complications associated with each antibiotic regimen.
Main Methods:
- Prospective, controlled, double-blind study design.
- Involved 496 patients undergoing abdominal surgery.
- Patients received either ceftriaxone or ampicillin plus metronidazole as single-dose antibiotic prophylaxis.
Main Results:
- Overall infectious complication rates were similar between groups (3.2% vs. 4.9%).
- Incisional wound infections, often caused by gram-negative rods, were more frequent with ampicillin-metronidazole.
- Deep wound infections were more common in the ceftriaxone group.
Conclusions:
- Ceftriaxone appears more effective than ampicillin-metronidazole for preventing incisional surgical site infections.
- Supplementing ceftriaxone with an antianaerobic agent may be beneficial for preventing deep wound infections.
- Regimen choice should consider the specific type of surgical site infection risk.