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Prophylaxis against infection. Single-dose cefonicid compared with multiple-dose cefamandole
S Garcia1, M L Lozano, J M Gatell
1Department of Orthopaedics, Hospital Clinic, Faculty of Medicine, Barcelona, Spain.
Abstract:
A total of 1489 patients were included in a prospective, randomized study that compared the efficacy of a single dose of cefonicid in 474 patients (Group I) with that of three doses of cefamandole in 510 patients (Group II) and five doses of cefamandole in 505 patients (Group III), for prophylaxis against infection after an operation on bone. The operations involved the insertion of a Moore prosthesis, an Ender and Küntscher nail, a bone-plate, or another device for internal fixation. Patients who had an open fracture or a total joint replacement were not included in the study. The three groups were similar with regard to mean age, sex ratio, duration of preoperative hospitalization, underlying risk factors, and type of operation. The rates of wound infection were not significantly different in the three groups (p = 0.8) or when the rates were stratified according to the type of operation (p greater than 0.3). Staphylococcus aureus and gram-negative bacilli were the most common infecting microorganisms. The rate of mortality related to infection was similar in all three groups (p = 0.2). No adverse side-effects of drugs were encountered. A single preoperative dose of cefonicid, three doses of cefamandole, and five doses of cefamandole were equally effective prophylaxis against infection of the wound in these patients.
Insights
A single dose of cefonicid and multiple doses of cefamandole showed equal effectiveness in preventing surgical site infections after bone operations. This study compared cefonicid prophylaxis with varying cefamandole regimens.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Prevention
- Pharmacology
Background:
- Surgical site infections (SSIs) are a significant complication following orthopedic bone surgery.
- Prophylactic antibiotic regimens aim to minimize SSI risk.
- Optimal antibiotic choice and dosage for bone fixation surgery prophylaxis require evaluation.
Purpose of the Study:
- To compare the efficacy of a single preoperative dose of cefonicid versus multiple doses of cefamandole for surgical prophylaxis in bone operations.
- To assess infection rates and adverse drug events across different antibiotic prophylaxis strategies.
Main Methods:
- Prospective, randomized study involving 1489 patients undergoing bone fixation surgery.
- Comparison of three groups: single-dose cefonicid, three-dose cefamandole, and five-dose cefamandole.
- Exclusion of patients with open fractures or total joint replacements; stratification by operation type.
Main Results:
- No significant difference in wound infection rates among the three prophylaxis groups (p = 0.8).
- Infection rates remained similar across operation types.
- Mortality related to infection was comparable across groups; no adverse drug effects were reported.
Conclusions:
- A single preoperative dose of cefonicid is as effective as three or five doses of cefamandole for preventing SSIs in patients undergoing bone fixation surgery.
- Both cefonicid and cefamandole demonstrate comparable safety profiles in this prophylactic setting.
- Current prophylactic strategies show equivalent efficacy, simplifying treatment decisions.