[Single preoperative dose of metronidazole plus gentamicin for antimicrobial prophylaxis in colorectal surgery].
OBJECTIVE
To prove that a single-preoperative dose (SD) of metronidazole plus gentamicin guarantees the same clinical effectiveness than the same dose administered in a multiple-perioperative schedule (MD), with a reduction of the direct costs.


METHODS
A retrospective cohort study with patients undergoing elective colorectal surgery between 1995 and 2003 was designed. Patients in the cohort of cases received a SD of metronidazole 1500 mg plus gentamicin 240 mg between 1999 and 2003. Patients included in the cohort of controls received the same dose of antibiotics in a MD schedule between 1995 and 1997. Clinical effectiveness was evaluated as length of stay, mortality and rate of surgical-related infections. Economic analysis was performed using direct costs of therapy exclusively.


RESULTS
414 patients were included in the cohort of MD and 978 were included in the cohort of SD. Total length of stay (standard deviation) was 15.1 (16.2 days), with a significant reduction in the SD cohort versus the MD cohort: 14.0 (15.4) days versus 17.5 (17.8) days (p < 0.001). No differences in mortality (overall rate 3.2%) or surgical infection rate (overall rate 8.6%) between cohorts were found. SD schedule produces a 35% cost-reduction per procedure.


CONCLUSIONS
Attending the clinical effectiveness, no differences between SD and MD cohorts were found. Therefore, according to logistics advantages and costs reduction, the SD of antibiotic is considered the most efficient option.
Ventura Cerdá
José Manuel
JM
Servicio de Farmacia, Hospital General de Castellón, Avenida Benicasim s/n, 12004 Castellón, Spain. ventura_jma@gva.es
Nomdedeu Guinot
Jesús
J
Alós Almiñana
Manuel
M
Yepes
Vicente Angel
VA
Pérez Salinas
Isabel
I
Salvador Sanchís
José Luis
JL
D000890:Anti-Infective Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D015331:Cohort Studies; D003108:Colonic Diseases / Q000601:surgery*; D005839:Gentamicins / Q000008:administration & dosage*; D006801:Humans; D008795:Metronidazole / Q000008:administration & dosage*; D008875:Middle Aged; D011300:Preoperative Care; D012002:Rectal Diseases / Q000601:surgery*; D012189:Retrospective Studies
D000890:Anti-Infective Agents; D005839:Gentamicins; D008795:Metronidazole