Single-dose cefotaxime versus 3 to 5 dose cefoxitin for prophylaxis of vaginal or abdominal hysterectomy

We evaluated a single 1-g dose regimen of cefotaxime versus the standard three to five 2-g cefoxitin regimen for prophylaxis in vaginal or abdominal hysterectomy to determine whether acceptable rates of morbidity could be achieved. The antibiotics were administered as follows: cefotaxime, 1 g im or iv on call to the operating room; cefoxitin, 2 g im or iv on call to the operating room, followed by 2 g intravenously at 6 hourly intervals for up to 24 h. The patients received a povidone-iodine vaginal preparation immediately before surgery; vaginal packs, when used, contained no antimicrobial agents. Surgical procedures were comparable for each antibiotic and surgery group. The results showed that among cefotaxime treated subjects who underwent hysterectomy only 1 of 37 (2.7%) vaginal cases and 5 of 60 (8.3%) abdominal cases developed operative site infections requiring parenteral antibiotics. For cefoxitin, 3 of 41 (7.3%) vaginal cases and 6 of 41 (14.6%) abdominal cases, similarly, required antibiotics. The incidence of postoperative infections was not different between regimens, irrespective of the type of hysterectomy, but considerable cost-savings by reduced drug and administration expenses were realized with the single-dose cefotaxime regimen.