Preventative antibiotics for penetrating abdominal trauma--single agent or combination therapy?
In this open, prospective, comparative study, 75 patients who sustained penetrating abdominal trauma were randomised to receive 1 of 3 antibiotic regimens preoperatively and for 3 to 5 days postoperatively. Group I received cefotaxime 2g 8-hourly, group II received cefoxitin 2g 6-hourly and group III received clindamycin (900 mg 8-hourly) and gentamicin 3 to 5 mg/kg/day in divided doses 8-hourly. The 3 groups were not statistically different in terms of age, sex, severity of injury, number of organs injured, colon injuries, shock, blood transfusions or positive intra-operative cultures. Septic complications occurred in 8% of patients in group I, in 4% of group II patients and in 8% of group III patients. Cefotaxime was the least costly regimen, followed by cefoxitin, then clindamycin and gentamicin. It may be concluded that single agent therapy with a broad spectrum cephalosporin is preferable to combination therapy on the basis of equivalent effectiveness, less toxicity and lower costs.
Bivins
B A
BA
Division of Trauma Surgery, Henry Ford Hospital, Detroit, Michigan.
Crots
L
L
Sorensen
V J
VJ
Obeid
F N
FN
Horst
H M
HM
D000007:Abdominal Injuries / Q000150:complications*; D001424:Bacterial Infections / Q000209:etiology / 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; D005839:Gentamicins / Q000627:therapeutic use*; D006801:Humans; D011446:Prospective Studies; D011897:Random Allocation; D014950:Wounds, Penetrating / Q000150:complications*
D002511:Cephalosporins; D005839:Gentamicins; D002981:Clindamycin; D002440:Cefoxitin; D002439:Cefotaxime