Single dose systemic antibiotic prophylaxis of surgical wound infections

The proper duration of antimicrobial use for the prevention of postoperative surgical infection has been a subject of controversy. Currently, more than 40 published clinical trials are available in which the efficacy of single dose surgical prophylaxis with parenteral antimicrobials has been studied. These studies have compared single doses versus multiple doses of the same agent, single doses of antimicrobial versus placebo, single doses of various antimicrobials, and a single dose of one agent versus multiple doses of another agent. In all trials in which single dose regimens were compared with multidose regimens, the single dose regimens resulted in a similar frequency of postoperative wound infections. Single antimicrobial doses, usually cephalosporins given immediately before operation, are effective in preventing wound infections in gastric, biliary, and transurethral operations, hysterectomies and cesarean sections. For colorectal operations, the value of single parenteral doses of various agents has been established; however, it is not clear if there is an added benefit when oral antimicrobials are also used. For open heart operations or those in which prosthetic materials are implanted, the value of single dose regimens has not been established.