Use of antibiotic prophylaxis in penetrating abdominal trauma

Information concerning the efficacy of prophylactic antibiotics in patients sustaining penetrating abdominal trauma is limited. Duration of such therapy is also uncertain. Thus a prospective, randomized, double-blind study was performed at Grady Memorial and City of Memphis Hospitals. A total of 360 patients sustaining penetrating abdominal trauma were randomized to one of three groups: group 1, cefotaxime perioperatively only; group 2, cefotaxime perioperatively plus postoperative doses every six hours for 24 hours; and group 3, cefazolin perioperatively plus postoperative doses every six hours for 24 hours. Postoperative infection of the incision or peritoneal cavity occurred in 20 (17%) of the patients in group 1, 13 (10%) in group 2, and 11 (9%) in group 3. Differences were not statistically significant. The occurrence of higher infection rates in group 1 may be explained by the greater number of patients sustaining shotgun wounds and rectal injuries. This study lends support to the practice of discontinuing antibiotic therapy on termination of the operative procedure. Cefotaxime has been found to be a reliable, effective agent for prophylaxis against infection in patients who have sustained penetrating abdominal trauma.