Peri-operative antibiotic cover in amputations using an amoxycillin-clavulanic acid combination

In a series of 64 patients requiring amputation for lower limb sepsis, the performance of a new antibiotic combination with beta-lactamase-inhibiting properties, amoxycillin plus clavulanic acid (A-CA) (Augmentin; Beecham) in the prophylaxis of postoperative wound sepsis, was compared with that of a combination of amoxycillin and ampicillin (A-A) (Suprapen; Bencard) and a control group. The sepsis rate following A-CA prophylaxis (12,9%) was significantly less than in the control group (x 2 = 18, 49; P less than 0,001). Although not attaining statistical significance (x 2 = 2, 12),, A-CA compared favourably with A-A (sepsis rate 35.3%) in the prevention of post-amputation wound sepsis. There was no statistically significant difference in the development of sepsis between wounds closed primarily and those left unsatured while under A-CA cover. It is concluded that peri-operative antibiotic cover for amputations in septic lower limb lesions is advisable and that A-CA is a valuable antibiotic in this situation.