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A randomized, double-blind trial of single dose piperacillin versus multidose cefoxitin in alimentary tract
Abstract:
For elective alimentary tract operations in which contamination is moderate, single dose prophylaxis with piperacillin is equivalent to triple dose cefoxitin, a well established and effective regimen. Both methods failed to control infection arising in the perineal wound after abdominoperineal resection. Just as is the case with drain site infection, such infection often evolves from postoperative contamination and, indeed, is in theory and in fact unlikely to be controlled by perioperative prophylaxis. This study is among the first of several examining the issue of single dose prophylaxis and will be the harbinger of other studies from other groups examining whether or not the course of therapeutic antibiotics can be safely shortened in patients with peritoneal contamination.
Insights
Single dose piperacillin prophylaxis is as effective as triple dose cefoxitin for moderate contamination in alimentary tract operations. Neither regimen controlled perineal wound infections, suggesting limitations of perioperative antibiotic prophylaxis.
Area of Science:
- Surgical Infection Prevention
- Antibiotic Prophylaxis
- Clinical Microbiology
Background:
- Moderate contamination in alimentary tract operations necessitates effective antibiotic prophylaxis.
- Established regimens like triple-dose cefoxitin are commonly used.
- The efficacy of single-dose antibiotic regimens requires further investigation.
Purpose of the Study:
- To compare the efficacy of single-dose piperacillin with triple-dose cefoxitin for surgical prophylaxis.
- To evaluate the effectiveness of these regimens in preventing surgical site infections, particularly in abdominoperineal resections.
- To explore the potential for shortening antibiotic courses in contaminated surgical procedures.
Main Methods:
- Elective alimentary tract operations with moderate contamination were studied.
- Patients received either single-dose piperacillin or triple-dose cefoxitin prophylaxis.
- Infection rates, including perineal wound infections, were monitored postoperatively.
Main Results:
- Single-dose piperacillin demonstrated equivalent efficacy to triple-dose cefoxitin in preventing infections for moderate contamination.
- Both prophylactic regimens were ineffective in controlling infections in the perineal wound after abdominoperineal resection.
- Perineal wound infections appear to originate from postoperative contamination, beyond the scope of perioperative prophylaxis.
Conclusions:
- Single-dose piperacillin is a viable alternative to multi-dose cefoxitin for surgical prophylaxis in specific gastrointestinal surgeries.
- Perioperative antibiotic prophylaxis has limitations in preventing infections arising from established postoperative contamination, such as in perineal wounds.
- This study supports further research into optimizing antibiotic duration for patients with peritoneal contamination.