The role of cephalosporins in surgical prophylaxis
Department of Community Health and Medicine, Tufts University School of Medicine, Boston, MA 02111.Journal of Antimicrobial Chemotherapy (Impact Factor: 5.31). 05/1989; 23 Suppl D(suppl D):61-70. DOI: 10.1093/jac/23.suppl_D.61
Worldwide, cephalosporins are the most widely used antibiotics for surgical prophylaxis. These drugs are recommended for prophylaxis because of their good safety profile, excellent antimicrobial activity against most of the bacteria causing postoperative wound infection, satisfactory penetration into critical tissues and, most importantly, a strong track record of efficacy in clinical trials. There are still unresolved questions about the choice of cephalosporin and the timing and duration of administration. In vaginal hysterectomy, Caesarian section, and biliary tract surgery a single preoperative dose of any one of several cephalosporins has been used effectively. There are no apparent benefits in using a longer course for prophylaxis, nor for choosing a third-generation cephalosporin rather than a first- or second-generation cephalosporin. Several cephalosporins have been employed successfully in cardiac surgery, mostly in trials using a 24-48 h regimen. A recent study with a single preoperative dose of ceftriaxone has produced favourable results. In elective colorectal surgery definitive conclusions are difficult because of limited controlled studies. The best results have been achieved with an oral bowel preparation such as neomycin-erythromycin. Metronidazole, combined with another agent to suppress facultative bacteria, has also produced excellent reduction in wound infections. While it is not firmly established that a systemic cephalosporin contributes to the proven good effects of an oral bowel preparation, there is evidence that the choice of the cephalosporin should be based, in part, on its activity against anaerobic bacteria.
Article: Cefotaxime and prophylaxis[Show abstract] [Hide abstract]
ABSTRACT: Cefotaxime, a third-generation cephalosporin, is active against many troublesome gram-negative organisms and anaerobes that now more frequently cause nosocomial infection. Single-dose cefotaxime, 1 g or 2 g administered 30 minutes prior to surgery, has been proven to be effective as prophylaxis for infection following gastrointestinal, biliary, obstetric, gynecologic, and genito-urinary procedures. When published trials are compiled, single-dose cefotaxime is more effective than multiple-dose cefazolin (p <0.01) in these types of surgery. Unfortunately, the dramatic increase in cephalosporin use has been accompanied by the emergence of resistant organisms such as enterococci and fungi. In Europe, some centers successfully prevent nosocomial pneumonia in intubated patients by decontaminating gastric contents with a combination of nonabsorbable antimicrobial agents including cefotaxime. Further trials may validate this concept for use in the United States.The American Journal of Medicine 04/1990; 88(4):S32-S37. DOI:10.1016/0002-9343(90)90325-8 · 5.00 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: We randomized 400 patients who were scheduled for an elective cardiovascular operation involving median sternotomy to receive cefamandole nafate or cefonicid in a prospective double-blind study. Three hundred fifty-seven patients were evaluable for prophylactic efficacy. Chest wound and donor site infections and early prosthetic valve endocarditis occurred more frequently with cefonicid (11 patients, 6.3%) than with cefamandole (4 patients, 2.2%) (p = 0.05). Three patients, all in the cefonicid group, required sternal debridement to control postoperative deep wound infections. Twenty-five miscellaneous postoperative infections (urinary tract infection, pneumonia, intravenous site infection, bacteremia, sepsis, Clostridium difficile diarrhea) occurred in 16 patients (9.19%) in the cefonicid group and four in 4 patients (2.19%) in the cefamandole group (p = 0.003). These data indicate that cefamandole is superior to cefonicid in preventing both surgical wound infections and miscellaneous nonsurgical infections after cardiovascular operations.The Annals of Thoracic Surgery 04/1990; 49(3):435-9. DOI:10.1016/0003-4975(90)90250-A · 3.85 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The value of antibiotic prophylaxis in abdominal hysterectomy was reviewed by meta-analysis. Two independent literature searches (1986-1988) yielded 150 relevant papers, however, only 17 (11.3%) papers met our inclusion criteria. The selected papers described prospective, randomized, blinded, placebo-controlled studies of patients undergoing elective abdominal hysterectomy. In 14 of 17 (82%) trials, first- or second-generation cephalosporins were used. Results pooled confirm that antibiotic prophylaxis will reduce infectious morbidity following elective abdominal hysterectomy. Hospital stay is little affected and significant levels of infectious morbidity remain.Pharmaceutisch Weekblad Scientific Edition 01/1991; 12(6A):296-8; discussion 299. DOI:10.1007/BF01967837
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.