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Double-blind trial of perioperative intravenous metronidazole prophylaxis for abdominal hysterectomy
Abstract:
A double-blind trial of perioperative intravenous metronidazole treatment to prevent infections at the operative site and unexplained fever after abdominal hysterectomy was conducted in 106 patients. Metronidazole prophylaxis reduced the rate of recovery of anaerobes from vaginal swabs for several days and prolonged the high rate of vaginal carriage of enterococci and aerobic gram-negative bacilli following hysterectomy. Although the fever index, calculated from the duration of a temperature above 37.3 degrees C, was significantly lower in the metronidazole-treated group than in the placebo-treated group, the frequency of postoperative infections, the proportion of patients requiring antibiotic treatment and the average duration of hospital stay were similar in the two groups. These results do not support the reported value of perioperative metronidazole prophylaxis in patients undergoing abdominal hysterectomy.
Insights
Perioperative intravenous metronidazole did not reduce postoperative infections or hospital stay after abdominal hysterectomy. While it lowered fever duration, it increased vaginal carriage of certain bacteria, questioning its prophylactic value.
Area of Science:
- Gynecology
- Infectious Diseases
- Surgical Prophylaxis
Background:
- Abdominal hysterectomy carries risks of surgical site infections and postoperative fever.
- Metronidazole is an antibiotic used to target anaerobic bacteria, often implicated in pelvic infections.
Purpose of the Study:
- To evaluate the efficacy of perioperative intravenous metronidazole in preventing surgical site infections and unexplained fever following abdominal hysterectomy.
Main Methods:
- A double-blind, placebo-controlled trial involving 106 patients undergoing abdominal hysterectomy.
- Patients received either intravenous metronidazole or a placebo perioperatively.
- Vaginal swabs were analyzed for bacterial recovery; fever index and infection rates were monitored.
Main Results:
- Metronidazole reduced anaerobic bacterial recovery from vaginal swabs but prolonged carriage of enterococci and aerobic gram-negative bacilli.
- The fever index was significantly lower in the metronidazole group.
- No significant differences were observed in infection frequency, need for antibiotics, or hospital stay duration between groups.
Conclusions:
- Perioperative intravenous metronidazole prophylaxis did not demonstrate a significant benefit in reducing overall postoperative infections or hospital stay after abdominal hysterectomy.
- The observed increase in carriage of certain aerobic bacteria warrants consideration.
- Current findings do not support the routine use of this regimen for preventing infections in this patient population.