title: Comparing a combination of penicillin G and gentamicin to a combination of clindamycin and amikacin as prophylactic antibiotic regimens in prevention of clean contaminated wound infections in cancer surgery.
abstract: OBJECTIVE
  Appropriate antibiotic selection and timing of administration for prophylaxis are crucial to reduce the likelihood of surgical site infection (SSI) after a clean contaminated cancer surgery. Our aim is to compare the use of two prophylactic antibiotic (PA) regimens as regards efficacy, timing, and cost.
  
  
  METHODS
  Two hundred patients with gastric, bladder, or colorectal cancer were randomized to receive preoperative PA, group A received penicillin G sodium and gentamicin and group B received clindamycin and amikacin intravenously. The demographic data of patients were collected, and they were observed for wound infections.
  
  
  RESULTS
  Infected wounds occurred in 19 patients with a rate of 9.5%. Highest incidence of SSI was among bladder cancer patients (14.2%); p=0.044. The rate of SSI was 11% in group A, and 8% in group B, p=0.469. The cost of PA administered in group A was significantly less than that of group B (21.96±3.22LE versus 117.05±12.74LE, respectively; p<0.001). SSI tended to be higher among those who had longer time for antibiotic and incision (≥30min) than those who had shorter time interval (<30min), (13% vs. 6.5%, respectively).
  
  
  CONCLUSIONS
  Both penicillin+gentamicin and clindamycin+amikacin are safe and effective for the prevention of SSI in clean contaminated operative procedures. In a resource limited hospital, a regimen including penicillin+gentamicin is a cost-effective alternative for the more expensive and broader coverage of clindamycin+amikacin. Timing of PA is effective in preventing SSIs when administered 30min before the start of surgery.
authors.affiliation: Clinical Pathology Department, National Cancer Institute, Cairo University, Egypt.
authors.forename: Hadir A
authors.initials: HA
authors.lastname: El-Mahallawy
authors.forename: Safaa Shawky
authors.initials: SS
authors.lastname: Hassan
authors.forename: Hassan Ibrahim
authors.initials: HI
authors.lastname: Khalifa
authors.forename: Mohamed M
authors.initials: MM
authors.lastname: El-Sayed Safa
authors.forename: Medhat Mohamed
authors.initials: MM
authors.lastname: Khafagy
mesh_terms: D000328:Adult; D000583:Amikacin / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000191:economics*; D002981:Clindamycin / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000601:surgery; D004359:Drug Therapy, Combination / Q000191:economics; D005260:Female; D005839:Gentamicins / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010400:Penicillin G / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000517:prevention & control; D013274:Stomach Neoplasms / Q000601:surgery; D013530:Surgical Wound Infection / Q000517:prevention & control*; D001749:Urinary Bladder Neoplasms / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D002981:Clindamycin; D000583:Amikacin; D010400:Penicillin G