Antimicrobial prophylaxis of infections in head and neck cancer surgery

429 patients undergoing surgery for head and neck tumors were involved in 4 consecutive, randomized clinical trials of antimicrobial prophylaxis: placebo versus ampicillin plus cloxacillin (2 g of each daily for 6 days), ticarcillin (5 g X 12, 8-hourly) versus carbenicillin (10 g X 12, 8-hourly) short carbenicillin prophylaxis (1 day) versus prolonged carbenicillin prophylaxis (4 days) and clindamycin (900 mg, 4 daily doses) versus clindamycin plus netilmicin (90 mg, 4 daily doses). Aerobic gram-negative strains were the microorganisms most frequently isolated either from colonized or infected wounds. The first controlled study showed a significant decrease in the rate of postoperative bacterial infections in the treated group as compared to the placebo-treated group (p less than 0.05). In all the subsequent treatment groups, postoperative infection rates ranged from 6 to 16%. Short prophylaxis was as effective as prolonged prophylaxis. A regimen directed mainly against anaerobes (clindamycin) did not seem of less value than broad spectrum regimens covering most aerobic gram-negative bacilli.