title: A randomized trial of one versus three doses of Augmentin as wound prophylaxis in at-risk abdominal surgery.
abstract: In a randomized prospective trial of prophylactic antibiotics in at-risk abdominal surgery, one dose of intravenous Augmentin (amoxycillin 250 mg and clavulanic acid 125 mg) on induction has been compared with three 8 hourly doses in 900 patients. Wound infection rates which included minor and delayed infections were very similar in those given one dose: 48/449 (10.7%) compared with those given three doses: 49/451 (10.9%) 95% confidence limits - 4.25% + 3.9%. There were more septic and sepsis-related deaths in those patients given one dose (14 deaths) than in those given three doses (7 deaths) P > 0.1 95% CL - 0.4% + 3.0%. However, there were more very elderly patients in the one dose group: 64% of the deaths were aged over 80 and all but one had an emergency operation. There was no difference in the other outcome measures studied which included non-fatal deep sepsis, length of postoperative hospital stay, duration of postoperative fever or the use of antibiotics for postoperative infection. One dose of a suitable intravenous antibiotic gives prophylaxis against wound infection in at-risk abdominal surgery which is at least as effective as multiple doses. However, there may be a risk of overwhelming systemic sepsis in very elderly patients having emergency surgery.
authors.affiliation: William Harvey Hospital, Ashford, Kent, UK.
authors.forename: T
authors.initials: T
authors.lastname: Bates
authors.forename: J V
authors.initials: JV
authors.lastname: Roberts
authors.forename: K
authors.initials: K
authors.lastname: Smith
authors.forename: K A
authors.initials: KA
authors.lastname: German
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000658:Amoxicillin / Q000008:administration & dosage*; D019980:Amoxicillin-Potassium Clavulanate Combination; D002969:Clavulanic Acids / Q000008:administration & dosage*; D004359:Drug Therapy, Combination / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000150:complications; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000401:mortality / Q000517:prevention & control*
chemical_list: D002969:Clavulanic Acids; D019980:Amoxicillin-Potassium Clavulanate Combination; D000658:Amoxicillin