title: A multicenter randomized trial of prophylaxis with intravenous cefepime + metronidazole or ceftriaxone + metronidazole in colorectal surgery. The 230 Study Group.
abstract: We compared two prophylactic antimicrobial regimens in 615 patients undergoing elective colorectal surgical procedures. Patients ranged in age from 19 to 92 years (median 66 years); the majority were male (54.0%) and most (77.7%) had neoplastic disease. All underwent mechanical bowel preparation. Patients were randomized to receive preoperative infusions of 2 g cefepime (n=307) or 2 g ceftriaxone (n=308), followed by 500 mg metronidazole. Patients were followed for up to 4 to 6 weeks after surgery. Antimicrobial prophylaxis was successful in preventing primary site infections in 92.8% of patients in the cefepime + metronidazole arm and 92.9% of patients in the ceftriaxone + metronidazole arm. Both regimens were well tolerated. A single dose of cefepime + metronidazole thus seems to be a very useful alternative to other regimens for prophylaxis in patients undergoing colorectal surgery.
authors.affiliation: Department of General Surgery, University of Rome Tor Vergata, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Zanella
authors.forename: F
authors.initials: F
authors.lastname: Rulli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D000077723:Cefepime; D002443:Ceftriaxone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002511:Cephalosporins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003107:Colorectal Surgery; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D000890:Anti-Infective Agents; D002511:Cephalosporins; D008795:Metronidazole; D002443:Ceftriaxone; D000077723:Cefepime