Antibiotics for penetrating abdominal trauma: a prospective comparative trial of single agent cephalosporin therapy versus combination therapy.
In this prospective, comparative study, 129 patients who sustained penetrating abdominal trauma were randomized to receive preoperatively, and for 3-5 days postoperatively, one of three antibiotic regimens: Group I--cefotaxime (CTX) (2 Gm Q8H), Group II--cefoxitin (2 Gm Q6H), or Group III--clindamycin (900 mg Q8H) and gentamicin (3-5 mg/kg/day in divided doses Q8H). The three groups were similar in terms of the following: age, sex, severity of injury, number of organs injured, colon injuries, shock, blood transfusions, or positive intraoperative cultures. Septic complications occurred as follows: Group I--6.9%, Group II--2.3%, and Group III--6.9%. The three regimens ranked as follows in terms of therapy costs: CTX less than cefoxitin less than clindamycin and gentamicin. It is concluded that single agent therapy with a cephalosporin is preferable to combination therapy on the basis of equivalent effectiveness, lower toxicity, and lower costs.
Bivins
B A
BA
Division of Trauma, Henry Ford Hospital, Detroit, Michigan 48202.
Crots
L
L
Obeid
F N
FN
Sorensen
V J
VJ
Horst
H M
HM
Fath
J J
JJ
D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000517:prevention & control*; D002439:Cefotaxime / Q000627:therapeutic use; D002440:Cefoxitin / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use*; D002981:Clindamycin / Q000627:therapeutic use*; D003365:Costs and Cost Analysis; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011897:Random Allocation; D014950:Wounds, Penetrating / Q000150:complications*
D002511:Cephalosporins; D005839:Gentamicins; D002981:Clindamycin; D002440:Cefoxitin; D002439:Cefotaxime