Single-dose cephalosporin for prevention of major pelvic infection after vaginal hysterectomy: cefazolin versus cefoxitin versus cefotaxime.
Antimicrobial overutilization accelerates the development of bacterial resistance. A prospective, randomized, blinded clinical trial of vaginal hysterectomy prophylaxis was designed to compare the efficacy, safety, and costs of cefazolin with those of cefoxitin and cefotaxime. Sixteen women (7.5%) developed febrile morbidity only, 10 (4.7%) developed major pelvic infection requiring parenteral antimicrobial therapy, and neither clinical nor laboratory adverse reactions of significance were observed. Anemia, diabetes, and additional surgical procedures were associated with a significantly increased incidence of postoperative infection; no regimen was more protective for women with or without these risk factors. Infections almost doubled hospital stay and the charges for health care. Diagnosis-related group reimbursement would have been more than $1,300 less than the mean hospital charge for women who developed infection. Utilizing cefazolin for prophylaxis and reserving cefoxitin and cefotaxime for therapy is cost and antimicrobial efficient.
D000328:Adult; D002437:Cefazolin / Q000008:administration & dosage* / Q000627:therapeutic use; D002439:Cefotaxime / Q000008:administration & dosage* / Q000627:therapeutic use; D002440:Cefoxitin / Q000008:administration & dosage* / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D007044:Hysterectomy; D010388:Pelvis; D011292:Premedication; D011446:Prospective Studies; D011897:Random Allocation; D012306:Risk; D013530:Surgical Wound Infection / Q000517:prevention & control*
D002440:Cefoxitin; D002437:Cefazolin; D002439:Cefotaxime