Duration of antibiotic therapy for penetrating abdominal trauma: a prospective trial.
BACKGROUND
The optimal duration of antibiotic use in penetrating abdominal trauma is incompletely defined. It is generally accepted that short-term antibiotics are appropriate for low-risk wounds. However, with colon injury and significant degree of injury, abdominal trauma index (ATI) more than 25, concern exists that short-term treatment is not adequate.


METHODS
The study was a prospective double-blind trial of 24-hour treatment (cefoxitin or cefotetan) compared with 5-day treatment in 515 patients. Major abdominal infections (MAI) included abscess, necrotizing fasciitis, and diffuse peritonitis.


RESULTS
MAI occurred in 8% of those patients with 1-day therapy and 10% with 5-day therapy. Subgroup analysis of high-risk groups (colon wounds and ATI of more than 25) showed the following MAI rates: colon, 1-day therapy, 14%; 5-day therapy, 15%; ATI of more than 25, 1-day therapy, 17%; 5-day therapy, 30%.


CONCLUSIONS
Regardless of contamination and degree of injury, 24-hour antibiotic therapy is satisfactory for all penetrating abdominal trauma.
Fabian
T C
TC
Department of Surgery, University of Tennessee, Memphis 38163.
Croce
M A
MA
Payne
L W
LW
Minard
G
G
Pritchard
F E
FE
Kudsk
K A
KA
D000007:Abdominal Injuries / Q000188:drug therapy* / Q000401:mortality; D000328:Adult; D000704:Analysis of Variance; D001424:Bacterial Infections / Q000188:drug therapy* / Q000209:etiology; D015313:Cefotetan / Q000008:administration & dosage / Q000627:therapeutic use*; D002440:Cefoxitin / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D006801:Humans; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000188:drug therapy* / Q000401:mortality
D015313:Cefotetan; D002440:Cefoxitin