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Related Experiment Videos

Single- versus multiple-dose antimicrobial prophylaxis for major surgery: a systematic review

M McDonald1, E Grabsch, C Marshall

  • 1Infectious Diseases Service, The Geelong Hospital, Victoria, Australia. sam-mal@gsat.edu.au

The Australian and New Zealand Journal of Surgery
|June 12, 1998
PubMed
Summary

Single-dose antimicrobial prophylaxis is recommended for major surgery, as this systematic review found no clear advantage of multiple-dose regimens in preventing surgical site infections (SSI). Further research is needed in understudied surgical areas.

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Area of Science:

  • Infectious Diseases
  • Surgical Sciences
  • Pharmacology

Background:

  • Single-dose antimicrobial prophylaxis is standard for major surgery, yet multiple-dose regimens persist in practice.
  • Recent studies have questioned the efficacy of single-dose prophylaxis.
  • This systematic review evaluates single versus multiple-dose prophylaxis for major surgery.

Purpose of the Study:

  • To determine the overall efficacy of single-dose versus multiple-dose antimicrobial prophylaxis for preventing surgical site infections (SSI) in major surgery.
  • To compare the effectiveness of different prophylaxis strategies across various surgical disciplines.

Main Methods:

  • Systematic review of prospective, randomized trials comparing single-dose and multiple-dose antimicrobial prophylaxis.
  • Studies identified via MEDLINE and other search strategies, limited to English language publications.

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  • Postoperative SSI rates were extracted, and odds ratios (OR) with 95% confidence intervals (CI) were calculated using fixed and random effects models.

    • Main Results:

    • Combined analysis (fixed and random effects) showed no statistically significant difference between single-dose and multiple-dose regimens in preventing SSI (OR 1.06, 95% CI 0.89-1.25 and OR 1.04, 95% CI 0.86-1.25, respectively).
    • Subgroup analyses revealed no significant differences based on antimicrobial type, blinding of wound assessment, duration of multiple-dose prophylaxis, or surgical discipline.

    Conclusions:

    • Continued use of single-dose antimicrobial prophylaxis for major surgery is supported by current evidence.
    • Further research is necessary, particularly in surgical disciplines that have been historically underrepresented in prophylaxis studies.