Comparison of three prophylactic antibiotic regimens in clean-contaminated head and neck surgery.
BACKGROUND
Although appropriate perioperative antibiotic prophylaxis has significantly reduced wound infection rates in clean-contaminated head and neck surgical procedures, controversy still remains regarding the optimal antibiotic regimen.


METHODS
In this prospective, double-blind clinical trial, 159 patients were randomized to receive amoxicillin-clavulanate, clindamycin plus gentamicin, or cefazolin intravenously up to 1/2 hour before surgery and at 6-hour intervals for an additional three doses.


RESULTS
An overall wound infection rate of 23% was observed. Thirteen (22.8%) infections occurred in the amoxicillin-clavulanate-treated group, 11 (21.2%) in the clindamycin plus gentamicin-treated group, and 13 (26%) in the cefazolin-treated group, which was not statistically significant. Only prior medical illnesses, such as chronic obstructive pulmonary disease and diabetes mellitus, correlated with an increased wound infection rate (p = 0.018).


CONCLUSIONS
Amoxicillin-clavulanate, clindamycin plus gentamicin, and cefazolin seem to have similar efficacy when administered prophylactically in clean-contaminated head and neck surgical procedures.
Rodrigo
J P
JP
Department of Otolaryngology, Hospital Central de Asturias, University of Oviedo, Spain.
Alvarez
J C
JC
Gómez
J R
JR
Suárez
C
C
Fernández
J A
JA
Martínez
J A
JA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000658:Amoxicillin / Q000627:therapeutic use; D019980:Amoxicillin-Potassium Clavulanate Combination; D019072:Antibiotic Prophylaxis; D002437:Cefazolin / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002969:Clavulanic Acids / Q000627:therapeutic use; D002981:Clindamycin / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use*; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007275:Injections, Intravenous; D007825:Laryngectomy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012307:Risk Factors; D013524:Surgical Flaps / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
D002969:Clavulanic Acids; D005839:Gentamicins; D002981:Clindamycin; D019980:Amoxicillin-Potassium Clavulanate Combination; D000658:Amoxicillin; D002437:Cefazolin