Antibiotic prophylaxis in genitourinary surgery: a comparison of cefotaxime and cefazolin

In a prospective, single-blind study, the efficacy of cefotaxime and cefazolin in the prevention of postoperative infection was compared in 133 patients admitted for elective genitourinary surgery (over half of whom were undergoing transurethral resection). In regimen 1, cefotaxime was given perioperatively (before, during, and up to two hours after surgery); in regimen 2, cefotaxime was given perioperatively and for 24 hours postoperatively; and in regimen 3, cefazolin was given perioperatively and for 24 hours postoperatively. All doses equaled 1 gm and were given either intramuscularly or by intravenous bolus. All patients had negative urine cultures preoperatively. The criterion for absence of infection was a negative urine culture (less than 10(5) organisms/ml) after surgery. At the final evaluation, 113 of the 133 patients (85%) were free of infection--39 of 45 (86.7%) on regimen 1, 40 of 45 (88.9%) on regimen 2, and 34 of 43 (79.1%) on regimen 3. All 20 patients who had postoperative infections had been catheterized for at least three days. Only 12 patients had temperatures greater than or equal to 101 F two days after surgery, and none had been clinically septic. No side effects other than a mild rash and itching in one patient on regimen 2 were reported. Both cefotaxime regimens were slightly more effective, bacteriologically and clinically, than the standard prophylactic cefazolin regimen. It is concluded that cefotaxime given perioperatively (up to two hours postoperatively) and/or up to 24 hours postoperatively effectively prevents postoperative complications associated with genitourinary surgery.