Topical versus systemic cephalosporin administration in elective biliary operations

Area of Science:

• Surgical Infectious Diseases
• Pharmacology
• Gastrointestinal Surgery

Background:

• Prophylactic antibiotic use in elective biliary tract operations remains a subject of debate.
• Optimizing antibiotic strategies is crucial for reducing postoperative complications.

Purpose of the Study:

• To evaluate the efficacy of topical versus systemic cefamandole for infection prophylaxis in elective biliary operations.
• To compare the effectiveness of isolated topical, isolated systemic, and combined antibiotic administration.

Main Methods:

• A prospective, randomized study involving 88 adult patients undergoing elective biliary operations.
• Patients were assigned to three groups: intravenous cefamandole, topical cefamandole lavage, or combined administration.
• Postoperative infections were monitored, and drug levels in blood, subcutaneous tissue, and peritoneum were measured.

Main Results:

• The topical cefamandole group experienced four infections (wound, urinary tract, cholangitis).
• The intravenous cefamandole group had one urinary tract infection; the combined group had four infections (wound, urinary tract, pneumonia).
• Topical cefamandole achieved higher drug concentrations in subcutaneous tissue and peritoneum compared to intravenous administration, with all groups reaching therapeutic serum levels.

Conclusions:

• Topical cefamandole lavage alone is sufficient prophylaxis for elective biliary operations, yielding results comparable to perioperative systemic administration.
• Topical administration leads to superior drug levels in local tissues and achieves therapeutic systemic levels.
• Combining systemic and topical cefamandole offers no additional advantage in preventing infections for these procedures.