Single-dose metronidazole versus 5-day multi-drug antibiotic regimen in excision of pilonidal sinuses with primary closure: a prospective randomised controlled double-blinded study.
OBJECTIVE
This pilot study examines whether single-dose intravenous metronidazole preoperatively is at least as effective as a broad-spectrum multi-drug regimen in preventing infection-related wound complications following excision of pilonidal sinuses with primary closure.


METHODS
A double-blinded study with 50 patients randomised to receiving either a single drug (intravenous metronidazole 500 mg) prophylaxis preoperatively or multi-drug cover (intravenous cefuroxime 1.5 g and metronidazole 0.5 g preoperatively, and oral co-amoxiclav 375 mg 8-hourly postoperatively). They will be reviewed 1, 2 and 4 weeks postoperatively. The wound will be graded as: I, healthy; II, redness and swelling of edges; III, abscess related to a suture; IV, spreading wound infection; V, wound breakdown. Other factors considered are the distance from the lowest wound margin to the anal verge, and previous pilonidal sinus surgery.


RESULTS
Results awaited.


CONCLUSIONS
Single-dose metronidazole seems an appropriate and low-cost antibiotic to consider for prophylaxis in pilonidal sinus surgery. This study will form the base for a trial to be conducted in larger numbers as a randomised controlled trial in order to have statistical power.
Chaudhuri
A
A
Department of General Surgery, Hinchingbrooke Hospital, Huntingdon, UK. arindam@chaudhuri.freeserve.co.uk
Bekdash
B A
BA
D019980:Amoxicillin-Potassium Clavulanate Combination / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D002444:Cefuroxime / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage*; D010864:Pilonidal Sinus / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D010865:Pilot Projects; D011446:Prospective Studies; D012008:Recurrence; D013530:Surgical Wound Infection / Q000517:prevention & control; D016896:Treatment Outcome; D006113:United Kingdom
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D008795:Metronidazole; D019980:Amoxicillin-Potassium Clavulanate Combination; D002444:Cefuroxime