A comparison of the prophylactic efficacy of ceftriaxone and cefotaxime in abdominal surgery.
BACKGROUND
Although ceftriaxone (R) and cefotaxime (C) are highly effective antibiotics, few studies have directly compared their prophylactic efficacy.


METHODS
In a prospective, randomized, double blind study of 1,013 patients undergoing abdominal surgery, the prophylactic use of ceftriaxone and cefotaxime were compared. Intravenous cephalosporin, 1 g, was given at induction of anesthesia, with intravenous metronidazole, 500 mg, also being given for colorectal surgery.


RESULTS
The difference in wound infection (R 8%, C 12%, P <0.05) was due to appendicectomies not receiving metronidazole, (R 6%, C 18%, P <0.03) and was no longer present when these cases were excluded from analysis (R 8%, C 10%). Of note chest and urinary tract infection (R 6%, C 11%, P <0.02) and "any" infection (R 20%, C 27%, P <0.05) were reduced with ceftriaxone.


CONCLUSIONS
Both antibiotics provide comparable wound prophylaxis as long as metronidazole is added for colorectal and appendiceal surgery. Ceftriaxone may be more versatile having the additional apparent benefits of reducing other postoperative infections, being less dependent on metronidazole as an adjunct and providing a more effective prophylactic cover against Staphylococcus aureus.
Woodfield
John C
JC
Department of Surgery, Dunedin School of Medicine, University of Otago, P.O. Box 913, Dunedin, New Zealand.
Van Rij
Andre M
AM
Pettigrew
Ross A
RA
van der Linden
Antje J
AJ
Solomon
Clive
C
Bolt
Donna
D
D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D002439:Cefotaxime / Q000008:administration & dosage*; D002443:Ceftriaxone / Q000008:administration & dosage*; D004066:Digestive System Diseases / Q000175:diagnosis / Q000601:surgery*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome
D002443:Ceftriaxone; D002439:Cefotaxime