Vaginal hysterectomy: cefuroxime, metronidazole or both?

Abstract

A randomized double-blind prospective study on the efficacy of single-dose antibiotic prophylaxis compared cefuroxime versus metronidazole versus the combination of both agents in vaginal hysterectomy. Overall antibiotic prophylaxis was effective in abscess prevention (one abscess in 68 patients). In the metronidazole group a significantly higher grade of morbidity was observed: febrile morbidity 41% versus 4% in the two other groups; bacteriuria 73% versus 17% in the cefuroxime group, versus 13% in the combined group; urinary tract infection 23%, versus 0% in the two other groups; post-operative prescription of antibiotics 41%, versus 0% in the two other groups. Febrile morbidity and bacteriuria correlated positively with Escherichia coli and Proteus spp. These micro-organisms were recovered significantly more often from the vagina of patients in the metronidazole group. Cefuroxime was successful, metronidazole failed in the prevention of minor morbidity. We could not observe any effect from the addition of metronidazole to the cefuroxime prophylaxis.

Antibiotic prophylaxis for hysterectomy, a prospective cohort study: cefuroxime, metronidazole, or both?

“…This largest evaluation (to date) enrolled 258 patients with AHs: postoperative wound infections fell from 12 to 6% with the use of metronidazole . Metronidazole may be more effective than placebo, but, from the few small comparative studies with other antimicrobial agents, support for the superiority of metronidazole is lacking …”

“…30 Metronidazole may be more effective than placebo, but, from the few small comparative studies with other antimicrobial agents, support for the superiority of metronidazole is lacking. [31][32][33] Compared with the first-generation cephalosporins, cefuroxime, as a second-generation drug, has a wider spectrum extending from Gram-positive cocci to Gramnegative rods. 34,35 Second-generation cephalosporins also show coverage against some anaerobes, such as the Grampositive peptostreptococci and the Gram-variable Mobiluncus rods, 36,37 which are abundant in women with BV.…”

Antibiotic Prophylaxis in Gynaecologic Procedures

“…11 Another trial comparing use of cefuroxime, metronidazole, or both showed an increased morbidity when metronidazole was added. 12 Treating bacterial vaginosis with metronidazole rectally for at least 4 days prior to vaginal hysterectomy appears to reduce the incidence of vaginal cuff infection (n = 59; 0 vs. 27%) but may be impractical given the possibility of surgery A . There is good evidence to recommend the clinical preventive action II-1: Evidence from well-designed controlled trials without randomization B .…”

“…(I-E) However, health care professionals could consider screening for sexually transmitted infections in high-risk populations . (III-C) 12 . There is insufficient evidence to support the use of antibiotic prophylaxis for an endometrial biopsy .…”