Ceftriaxone (Rocephin) in abdominal trauma.
A prospective study was undertaken to evaluate the use of ceftriaxone in patients with abdominal trauma admitted to our hospital over a period of 6 months. Because of the large trauma load and an unacceptable waiting period before surgery combined with the fact that many patients on 6-hourly antibiotic regimes often did not receive their second and third doses, it was decided to use ceftriaxone because of its long half-life with maintenance of fluid and tissue concentrations for 24-48 hours. Because ceftriaxone is not reliably effective against anaerobic organisms such as Bacteroides fragilis, it was decided to add metronidazole as a combined initial dose. Two hundred ninety patients were entered in this trial, of which there were 259 stab wounds (89.3%), 20 missile injuries (6.9%), and 11 blunt injuries (3.8%). It was found that the mean delay between injury and initial dosage of ceftriaxone was 9.1 hours, with a range of 1-126 hours, and the mean delay between antibiotic therapy and operation 6.3 hours, with a range of 0-39 hours. The organs most frequently injured were the small bowel, the large bowel, the stomach, and the liver. Wound infection developed in only 4 patients (1.4%); intra-abdominal sepsis did not occur; and 35 patients (12%) developed respiratory infections. There were no deaths. We conclude that ceftriaxone, because of its 24-hour dosage was not only convenient but also adequate to prevent intra-abdominal sepsis and there was no difference in cost between this product and our previous protocol of 6-hourly antibiotic regime.
van Rensburg
L C
LC
Department of Surgery, Faculty of Medicine, University of Stellenbosch, Republic of South Africa.
Warren
B
B
Warren
V
V
Müller
R
R
D000007:Abdominal Injuries / Q000382:microbiology* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D002443:Ceftriaxone / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011292:Premedication; D011300:Preoperative Care; D011446:Prospective Studies; D013997:Time Factors; D014946:Wound Infection / Q000517:prevention & control*; D014950:Wounds, Penetrating / Q000382:microbiology / Q000601:surgery
D002443:Ceftriaxone