Document Detail

Timing of prophylactic antibiotics in abdominal surgery: trial of a pre-operative versus an intra-operative first dose.
MedLine Citation:
PMID:  2645013     Owner:  NLM     Status:  MEDLINE    
When prophylactic antibiotics are used in abdominal surgery it is customary to give the first dose before the operation. Whilst intra-operative antibiotics may be effective in elective surgery, there may be an advantage to starting pre-operatively when there is already an infective focus such as appendicitis. Antibiotics started pre-operatively (group P) have been compared with antibiotics started after initial abdominal exploration (group T). Three intravenous doses of 500 mg metronidazole plus 1 g cephazolin were given in a randomized, double-blind study of 700 emergency and elective high-risk abdominal operations. Antibiotic plasma concentrations at the end of the operation were significantly lower in group P but lay well within the therapeutic range. Wound infection rates, which included minor and delayed infections, were similar in both groups (group P, 57 of 342, 16.7 per cent; group T, 55 of 358, 15.4 per cent; 95 per cent confidence intervals for the difference being -4.1 to +6.7 per cent. In appendicitis, wound infection rates were 12.1 and 13.9 per cent for groups P and T respectively. However, non-fatal deep sepsis was more common in group P (nine cases) than in group T (two cases) (chi 2 = 4.9, P less than 0.05). Postoperative infection was twice as common in obese patients whose body mass index (BMI) was greater than or equal to 26 (39 of 132, 30 per cent) than in thin patients whose BMI was less than 24 (41 of 288, 14 per cent; chi 2 = 13.8, P less than 0.001). This study failed to show any advantage to starting antibiotics pre-operatively, even in appendicitis.
T Bates; G Siller; B C Crathern; S P Bradley; R D Zlotnik; C Couch; R D James; C M Kaye
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  The British journal of surgery     Volume:  76     ISSN:  0007-1323     ISO Abbreviation:  Br J Surg     Publication Date:  1989 Jan 
Date Detail:
Created Date:  1989-03-30     Completed Date:  1989-03-30     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0372553     Medline TA:  Br J Surg     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  52-6     Citation Subset:  AIM; IM    
William Harvey Hospital, Ashford, Kent, UK.
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MeSH Terms
Abdomen / surgery*
Aged, 80 and over
Cefazolin / administration & dosage*,  therapeutic use
Clinical Trials as Topic
Double-Blind Method
Drug Administration Schedule
Drug Therapy, Combination / therapeutic use
Intraoperative Care*
Metronidazole / administration & dosage*,  therapeutic use
Middle Aged
Random Allocation
Risk Factors
Surgical Wound Infection / prevention & control
Reg. No./Substance:
25953-19-9/Cefazolin; 443-48-1/Metronidazole

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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