Prophylactic antibiotherapy in abdominal surgery. First- vs third-generation cephalosporins
N. Rotman, J. M. Hay, F. Lacaine and P. L. Fagniez
Service de Chirurgie Digestive, Hopital Henri-Mondor, Creteil, France.
To compare the efficiency of antibioprophylaxis by cefazolin sodium or
cefotaxime sodium, 3137 consecutive patients undergoing abdominal surgery
were included in a prospective, randomized, controlled, multicenter study.
The patients were divided into four strata, according to the degree of
contamination during the operation and the risk factors. Within each
stratum, the patients were randomized into three groups of treatment: (1)
cefazolin, (2) cefotaxime, and (3) nontreatment (control). Antibiotics were
administered perioperatively in three intravenous doses of 1 g at
eight-hour intervals. Patients undergoing colon surgery or with peritonitis
at the time of the operation were excluded from the study. The wound
abscess rate was significantly lower in the treated groups than in the
control group, except in stratum 3 (contaminated surgery). The percentage
of postoperative peritonitis was twice as low in the treated groups as in
the control group. There was no difference between the groups receiving
cefazolin or cefotaxime. The patients in the treated groups received
significantly less postoperative antibiotics than the patients in the
control group. In terms of cost, antibioprophylaxis by cefazolin seems to
be warranted in all operations with a low anaerobic contamination.
