Stratified duration of prophylactic antimicrobial treatment in emergency abdominal surgery. Metronidazole-fosfomycin vs. metronidazole-gentamicin in 381 patients.
Consecutive adult patients requiring emergency abdominal surgery were randomly allocated to preoperative treatment with metronidazole-gentamicin (M-G) or metronidazole-fosfomycin (M-F). Postoperative continuation of antibiotics depended on the estimated risk of septic complications. Peroperatively the cases were stratified as group A, acute inflamed appendicitis, or absence of septic disorder--no postoperative antibiotics, group B, gangrenous appendicitis or cholecystitis or intestinal obstruction without resection, or operations with contamination regarded as minor (gastrotomy or enterotomy)--three further doses of antibiotics, or group C, perforated appendicitis, perforation of the alimentary tract, generalized peritonitis or gross contamination--antibiotics continued for 5 days. Assessment for septic complications was made in 381 patients (191 M-G, 190 M-F). The total incidence was 4.8% (M-G 7.8%, M-F 1.6%, p less than 0.01). The difference was mainly due to higher infection rate in patients stratified to group C and randomized to M-G. Stratification thus permitted restricted duration of antibiotic treatment with a low septic complication rate, significantly less with M-F than with M-G regimen.
Andåker
L
L
Höjer
H
H
Kihlström
E
E
Lindhagen
J
J
D000006:Abdomen, Acute / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001064:Appendicitis / Q000601:surgery; D002764:Cholecystitis / Q000601:surgery; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination; D005260:Female; D005578:Fosfomycin / Q000627:therapeutic use*; D005839:Gentamicins / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use*; D008875:Middle Aged; D010538:Peritonitis / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control*; D011897:Random Allocation; D018805:Sepsis / Q000517:prevention & control*
D005839:Gentamicins; D008795:Metronidazole; D005578:Fosfomycin