A comparative analysis of preoperative single-dose antimicrobial therapy versus extended postoperative antimicrobial...

Gallbladder stones are the most prevalent condition affecting the biliary system, with varying incidence rates worldwide. Given the low occurrence of post-operative infections following laparoscopic cholecystectomy, the necessity of prophylactic antibiotic administration is often debated. Several clinical trials have demonstrated that a single pre-operative dose of antibiotics is just as effective as multiple doses. This study aims to compare the effects of single-dose versus multiple-dose antibiotics in laparoscopic cholecystectomy, specifically regarding post-operative infection-related complications. This prospective comparative study was conducted in a tertiary care hospital, Tamil-Nadu for a period of 18 months. Patients were randomly allocated into the study and control groups using a computer-generated simple randomization sequence in a 1:1 allocation ratio. No block randomization or stratification based on age, ASA grade, or other baseline variables was applied, and single dose of cefoperazone and sulbactam given at the time of induction to one group and in the other group cefoperazone + sulbactum 1 gm 1-0-1 was continued post-operatively in the other group for 5 days and Allocation concealment was ensured using sequentially numbered, opaque, sealed envelopes (SNOSE), which were opened only after patient enrolment. Patients were followed up for four weeks to study the post-operative infections and related complications. Due to the nature of the intervention (single-dose vs. extended antibiotic regimen), blinding was not feasible. The study was therefore conducted as an open-label trial. The majority of participants were between 31 and 40 years old, with a slightly higher proportion of males compared to females. Baseline characteristics were largely comparable between the two groups, except for a significantly higher proportion of ASA Grade II patients in the single-dose group compared to the extended-regimen group (77.8% vs. 57.8%, p = 0.034). The growth of organisms showed no variation between the two groups, and the incidence of surgical site infections (SSIs) was comparable, with no statistically significant difference (p > 0.05). Surgical site infection occurred in 3 of 45 patients (6.7%) in the single-dose group and 2 of 45 patients (4.4%) in the extended postoperative antibiotic group. This difference was not statistically significant p value 0.900. Single-dose prophylactic antibiotic administered at the induction of anesthesia is just as effective as multiple-dose antibiotic therapy continued post-operatively in preventing post-operative infections among patients undergoing laparoscopic cholecystectomy.