Prospective, randomized, double-blind study of prophylactic antibiotics in axillary lymph node dissection.
BACKGROUND
Antibiotic prophylaxis is controversial in patients undergoing axillary lymph node dissection (ALND). We determined whether preoperative antibiotics decreased incidence or treatment cost of infectious complications following ALND.


METHODS
Two hundred patients entered this prospective, randomized, double-blind trial. Patients received either placebo or cefonicid preoperatively. Loco-regional signs of infection were monitored for 4 weeks postoperatively.


RESULTS
There was a trend toward fewer infections in the prophylactic group (placebo 13% versus cefonicid 6%; P = 0.080). Cefonicid significantly decreased severe infections requiring hospitalization (placebo 8% versus cefonicid 1%; P = 0.033). Cefonicid also decreased the treatment cost of infection per patient ($49.80 versus $364.87).


CONCLUSIONS
We demonstrated a trend toward fewer overall infections and significantly fewer severe infections in patients given prophylactic antibiotics, which translated into a decrease in the cost of treatment for infectious complications. These findings support antibiotic prophylaxis for patients undergoing ALND.
Bold
R J
RJ
Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Mansfield
P F
PF
Berger
D H
DH
Pollock
R E
RE
Singletary
S E
SE
Ames
F C
FC
Balch
C M
CM
Hohn
D C
DC
Ross
M I
MI
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D001365:Axilla; D015790:Cefonicid / Q000008:administration & dosage* / Q000191:economics; D002511:Cephalosporins / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008197:Lymph Node Excision / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control
D002511:Cephalosporins; D015790:Cefonicid