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Amoxycillin-clavulanic acid (Augmentin) versus metronidazole as prophylaxis in hysterectomy: a prospective,
E M Brown1, J Depares, A A Robertson
1University Hospital of Wales, Heath Park, Cardiff.
Abstract:
In order to determine the most effective regimen for the prevention of infection after elective hysterectomy, 300 patients were randomly assigned to receive three perioperative doses of either amoxycillin-clavulanic acid (1.2 g intravenous) or metronidazole (1 g suppository). Of the 280 patients who were assessable 138 were given amoxycillin-clavulanic acid and 142 received metronidazole; 268 underwent abdominal hysterectomy and 12 had vaginal hysterectomy. Patients in the amoxycillin-clavulanic acid group had significantly less infectious morbidity (13.8%) than those in the metronidazole group (33.1%). There were also statistically significant differences in favour of amoxycillin-clavulanic acid with respect to operative site infection, duration of hospital stay, need for postoperative antimicrobials, and surgery for operative site infection. But for one isolate of Bacteroides fragilis, all pathogens isolated from wound infections in the metronidazole group were aerobes. No anaerobes were isolated from patients in the amoxycillin-clavulanic acid group. The results suggest that prophylaxis for hysterectomy should consist of an agent, or combination of agents, with activity against both aerobic and anaerobic bacteria. Amoxycillin-clavulanic acid fulfils this criterion and appears to be effective and safe.
Insights
Amoxycillin-clavulanic acid significantly reduced infectious morbidity after hysterectomy compared to metronidazole. This antibiotic regimen is effective for preventing surgical site infections in women undergoing hysterectomy.
Area of Science:
- Infectious Diseases
- Surgical Prophylaxis
- Pharmacology
Background:
- Elective hysterectomy carries a risk of postoperative infection.
- Optimizing prophylactic antibiotic regimens is crucial for patient outcomes.
Purpose of the Study:
- To compare the efficacy of amoxycillin-clavulanic acid versus metronidazole for preventing infection after elective hysterectomy.
- To identify the most effective perioperative antibiotic prophylaxis.
Main Methods:
- A randomized trial involving 300 patients undergoing elective hysterectomy.
- Patients received either intravenous amoxycillin-clavulanic acid (1.2 g) or a metronidazole (1 g) suppository perioperatively.
- Infectious morbidity, operative site infections, and hospital stay were assessed.
Main Results:
- Amoxycillin-clavulanic acid group had significantly lower infectious morbidity (13.8%) compared to the metronidazole group (33.1%).
- Reduced rates of operative site infection, shorter hospital stays, and fewer postoperative antimicrobial needs were observed with amoxycillin-clavulanic acid.
- Pathogen analysis indicated amoxycillin-clavulanic acid's effectiveness against both aerobic and anaerobic bacteria.
Conclusions:
- Amoxycillin-clavulanic acid is a safe and effective prophylactic agent for preventing infection after hysterectomy.
- Prophylaxis should target both aerobic and anaerobic bacteria, a criterion met by amoxycillin-clavulanic acid.