title: Double-blind comparison of cefazolin and ceftizoxime for prophylaxis against infections following elective biliary tract surgery.
abstract: Antibiotics have been shown to reduce the incidence of wound infections after elective biliary tract procedures. Cefazolin and cefoxitin are among the agents most commonly promoted for this purpose. Cefoxitin has been substituted with ceftizoxime in many institutions; however, the role of ceftizoxime as a prophylactic agent in this setting has not been determined. To assess the comparative prophylactic efficacies of cefazolin and ceftizoxime in biliary tract surgery, we conducted a double-blind, randomized prospective clinical trial in a tertiary-care teaching hospital. Adult patients were randomized to one of two treatment groups and received a 30-min preoperative dose of study drug and as many as two postoperative doses at 12 and 24 h, depending on hospitalization status. Cefazolin and ceftizoxime were given as 1,000-mg doses. Patients with infections, those receiving prior antibiotics, or those with beta-lactam allergies were excluded. Over the 19-month study tenure, 167 patients were enrolled. Seventeen patients were excluded from analysis because of protocol violations. Of the 150 evaluable patients (72 and 78 receiving cefazolin and ceftizoxime doses, respectively), there was no significant difference among groups regarding sex, age, weight, preoperative Apache II score, baseline chemistry, and hematological parameters. Groups were also equivalent regarding the surgeon, type of procedure, characteristics (blood loss, drains, organ injury, and complications), and duration of hospital stay (mean, 5.6 versus 4.3 days [P = 0.31]). No clinical evidence of infection (7-day hospital stay and 30-day follow-up) was identified in 93% of cefazolin and 92% of ceftizoxime patients (P = 1.0). Microbiological confirmation was found in only 18% of primary-site infections. In conclusion, cefazolin and ceftizoxime appear to be equivalent for the prevention of infection in biliary tract surgery with the dosage regimens studied.
authors.affiliation: Department of Pharmacy, Vancouver Hospital and Health Sciences Centre, British Columbia, Canada. jewesson@unixg.ubc.ca
authors.forename: P J
authors.initials: PJ
authors.lastname: Jewesson
authors.forename: G
authors.initials: G
authors.lastname: Stiver
authors.forename: A
authors.initials: A
authors.lastname: Wai
authors.forename: L
authors.initials: L
authors.lastname: Frighetto
authors.forename: D
authors.initials: D
authors.lastname: Nickoloff
authors.forename: J
authors.initials: J
authors.lastname: Smith
authors.forename: L
authors.initials: L
authors.lastname: Schwartz
authors.forename: K
authors.initials: K
authors.lastname: Sleigh
authors.forename: D
authors.initials: D
authors.lastname: Danforth
authors.forename: C
authors.initials: C
authors.lastname: Scudamore
authors.forename: A
authors.initials: A
authors.lastname: Chow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D001662:Biliary Tract Surgical Procedures; D002437:Cefazolin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D015296:Ceftizoxime / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D002511:Cephalosporins / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D002511:Cephalosporins; D015296:Ceftizoxime; D002437:Cefazolin