Single Dose Ceftriaxone as Prophylaxis for Sepsis in Colorectal Surgery

Abstract

During the period May 1986 to July 1989, a prospective, double blind, randomized trial of antibiotic prophylaxis in colorectal surgery was undertaken at the Royal Brisbane Hospital. Three hundred and thirty patients were considered eligible for the trial. Three regimens were compared: a combination of 2 g ceftriaxone and 1 g metronidazole; a single dose of 2 g ceftriaxone; or 1 g cefazolin and 1 g metronidazole, as antibacterial prophylaxis in colorectal surgery. Fifty patients were excluded from analysis. The overall incidence of wound sepsis was 7.9% (22 patients). There was no statistical difference in the incidence of wound infections between the three groups. The presence of drains and the non‐performance of a bowel anastomosis at the time of surgery predisposed patients to wound infection. Staphylococcus aureus or Sfaphylococcus epidermidis were the cause of wound infection in 16 cases. Patients in the cefazolin and metronidazole group had a significantly higher number of postoperative urinary tract and respiratory tract infections than the other two groups combined (P < 0.01). There did not appear to be any change in sensitivity patterns to ceftriaxone during the 3 year trial. During the 3 year period of the study, ceftriaxone was found to be a safe and effective drug in antibacterial prophylaxis in colorectal surgery.

Perioperative Infection Prophylaxis and Risk Factor Impact in Colon Surgery

“…Although in one study, the authors concluded that it is not always necessary to give metronidazole in addition to ceftriaxone for perioperative prophylaxis [7], many authors have recommended this combination as advantageous [8,9]. In the present study, metronidazole was combined with ceftriaxone in approximately 65% of cases, compared to 80% with other cephalosporins and only approximately 50% with penicillin.…”

“…In a prospective randomized double-blind study of perioperative prophylaxis with ceftriaxone 2 g B metronidazole versus cefazolin 1 g + metronidazole in colorectal surgery [7], postoperative airway and urinary tract infections were more frequent with cefazolin (p ! 0.01).…”

Clinical practice guidelines for antimicrobial prophylaxis in surgery

“…agents, most commonly metronidazole. 452,[459][460][461][462] However, in all but one of these studies, a combination of a secondor third-generation cephalosporin plus metronidazole was no more effective than the cephalosporin alone. The use of third-or fourthgeneration cephalosporins for routine antimicrobial prophylaxis is not recommended as use may lead to development of resistant organisms.…”

“…456,460,461 In some studies, second-or thirdgeneration cephalosporins were combined with other i.v. agents, most commonly metronidazole.…”

Perioperative Antibiotikaprophylaxe bei offenen urologischen Eingriffen

“…Eine Reihe von antibiotikaorientierten Studien scheinen dagegen aber den Wert einer Prophylaxe zu bestätigen [29,35,43]. Das Design der genannten Studien weist aber in der Regel Schwächen auf, da diese nicht placebokontrolliert waren oder Daten aus der Dickdarmchirurgie über-nommen wurden.…”