Oral versus single intravenous bolus dose antibiotic prophylaxis against postoperative surgical site infection in external dacryocystorhinostomy for primary acquired nasolacrimal duct obstruction – A randomized study

Abstract

Purpose: To compare the efficacy of a single perioperative bolus dose of intravenous antibiotic versus postoperative oral antibiotic prophylaxis for prevention of surgical site infection (SSI) in external dacryocystorhinostomy (DCR) for primary acquired nasolacrimal duct obstruction (PANDO). Methods: This was a prospective randomized controlled study with a noninferiority design. Patients undergoing external DCR surgery were randomized into two groups A and B. Patients in group A received a single bolus dose of intravenous cefazolin 1 g at surgery, whereas those in group B received oral cephalexin 500 mg postoperatively twice a day for 5 days. Allocation concealment was ensured by sequentially numbered opaque sealed envelopes (SNOSEs). Both groups were advised identical postoperative local wound care regimens. Any clinical evidence of SSI at 4 weeks of follow-up in either group was the main outcome measure. Results: In all, 338 patients randomized into two groups of 169 patients each participated in this study. At follow-up of 4 weeks, only one patient in group B developed postoperative SSI. None in group A developed postoperative SSI. Other potential risk factors for postoperative SSI were also analyzed by univariate and multivariate analyses but none achieved statistical significance in either group. Conclusion: Our results demonstrate that a single bolus dose of perioperative intravenous antibiotic offers adequate prophylaxis against postoperative SSI and compares favorably with the more commonly used oral antibiotic prophylaxis in external DCR for PANDO in our population and our practice scenario.

Surgical Antimicrobial Prophylaxis in Patients of Neonatal and Pediatric Age Subjected to Eye Surgery: A RAND/UCLA Appropriateness Method Consensus Study

“…Patients in the first group received a single bolus dose of intravenous cefazolin 1 g during surgery, whereas those in the second group received oral cephalexin 500 mg after surgery twice daily for 5 days. The results demonstrated that the efficacy in SSI prevention of a single dose of peri-operative intravenous antibiotic was comparable to that offered by the most widely used oral antibiotic prophylaxis [37].…”

Evidence-Based Medicine: Systemic Perioperative Antibiotic Prophylaxis for Prevention of Surgical-Site Infections in Plastic and Reconstructive Surgery

“…Five summary-of-findings tables and five clinical summary tables were created corresponding to clinical sections of Plastic and Reconstructive Surgery (Breast, Cosmetic, Hand/Peripheral Nerve, Pediatric/Craniofacial, and Reconstructive sections). Of the 138 included RCTs, 18 were breast (Tables 2 and 3), 10–27 10 cosmetic (Tables 4 and 5), 28–37 21 hand/peripheral nerve (Tables 6 and 7), 38–58 61 pediatric/craniofacial (Tables 8 and 9), 16,59–118 and 41 reconstructive (Tables 10 and 11). 16,28,38–42,54–56,119–149 Forest plots are provided for all comparisons.…”

“…118 Evidence: Uncertain support for preoperative systemic antibiotics. 117,118 4.8.2 Open Fractures. Preoperative and postoperative antibiotics for 1 day may not decrease SSI compared with preoperative and postoperative antibiotics for 5 days, but with very low certainty (RR, 0.44; 95% CI, 0.04 to 4.60; 62 participants; one study; P = 0.49; very-low-certainty evidence).…”

Implementing the Protocol of Perioperative Narrow-spectrum Antibiotic Prophylaxis in the Surgical Wards of Mofid Children’s Hospital in 2019 - 2020, A Comparative Study

“…In many surgical centers, antibiotic prophylaxis either is compromised by prescribing wrong antibiotics, or the dose and time intervals are not according to recommended guidelines (15). In a study in India in 2019, a single bolus dose of intravenous antibiotics given before external dacryocystorhinostomy for acquired nasolacrimal duct obstruction to prevent post-surgical infections was as effective as oral antibiotics administered for five days (16). In a study in Taiwan in 2004, one-day versus three-day antibiotic prophylaxis with cefazolin showed no difference in preventing SSI up to one month after coronary artery bypass graft (13).…”