Effectiveness of single dose prophylaxis with cefotaxime and metronidazole compared with three doses of cefotaxime alone in elective colorectal surgery
Håkansson, T.; Raahave, D.; Hansen, O.H.; Pedersen, T.
European Journal of Surgery 159(3): 177-180
1993
ISSN/ISBN: 1102-4151 PMID: 8102894 Document Number: 412684
Objective: To compare three doses of cefotaxime alone with a single dose of cefotaxime and metronidazole for the prophylaxis of infection after elective colorectal operations. Design: Prospective random control trial. Setting: Hillerod and Frederiksberg Hospitals, Copenhagen, Denmark. Subjects: 660 consecutive patients who were to undergo elective colorectal operations during a 48 month period (January 1987 - January 1991); 93 (14%) were withdrawn after randomisation leaving 567 for assessment. Interventions: Mechanical bowel preparation, and then either cefotaxime (Claforan) 2 g intravenously at induction of anaesthesia and 3 and 9 hours later (n = 280) or a single dose of cefotaxime 2 g plus metronidazole (Flagyl) 1.5 g intravenously at induction of anaesthesia (n = 287). Results: 44 patients with the cefotaxime group developed wound infection (16%) compared with 19 (7%) in the combined group (p lt 0.001). In the cefotaxime group 22 of the 241 patients who had an anastomosis developed leaks (9%) compared with 8 of the 239 in the cefotaxime/metronidazole group (3%). There were no differences in the incidence of intra-abdominal abscesses or burst abdomens. The most common organisms isolated from wounds were Escherichia coli and Bacteriodes fragilis. Conclusion: One dose of cefotaxime and metronidazole is active against a wide range of organisms and resulted in significantly fewer wound infections than three doses of cefotaxime alone.