Single-dose antibiotic prophylaxis in contaminated abdominal surgery

J. C. Hall, J. M. Watts, L. Press, P. O'Brien, J. Turnidge and P. McDonald
Department of Surgery, Royal Perth Hospital, Western Australia.

Although perioperative antibiotic cover reduces the incidence of septic complications associated with abdominal surgery, the optimum duration of antibiotic exposure is open to question. This clinical trial compared the efficacy of a single dose of moxalactam (1 g intravenously) with an extended course of moxalactam (1 g intravenously for eight doses) in 1027 patients undergoing contaminated abdominal surgery. The wound infection rate was 5.4% (28/519) for the single-dose schedule and 6.1% (31/508) for the extended-cover regimen (the respective 95% confidence intervals being 3.6% to 7.7% and 4.2% to 8.6%). Over 80% of all patients undergoing abdominal surgery during the period of study were entered into the trial. There was no significant difference in the incidence of other complications between the two groups under study. It is concluded that a single dose of moxalactam is as effective as a 48-hour course when attempting to prevent infection after contaminated abdominal surgery.