title: Does routine prophylactic oral flucloxacillin reduce the incidence of post-circumcision infections?
abstract: BACKGROUND
  Cost-effective and safe practices are required for the scale-up of medical male circumcision (MMC), a strategy recommended for biomedical HIV prevention.
  
  
  METHODS
  A retrospective medical record review was conducted of post-circumcision wound infection incidence at a massive MMC program in Soweto, South Africa. We compared patients who received routine 250 mg prophylactic flucloxacillin 4 times daily orally for 5 days with those who did not receive prophylaxis. Patients with HIV infection and those with missing prophylaxis data were excluded from the analysis. Collated data included prophylaxis received, age, return for follow-up, and presence and grading of wound infection at follow-up.
  
  
  RESULTS
  In total, 1,291 patients were eligible: 646 flucloxacillin recipients and 645 non-recipients. Median age of flucloxacillin recipients was 24 years (interquartile range 20-29 years) and for nonrecipients it was 23 years (interquartile range 16-28 years). Eighty-one percent of flucloxacillin recipients and 87% of nonrecipients (P = .0019) returned for follow-up. Wound infection was present in 0.7% (5 of 646) of flucloxacillin recipients and 1.2% (8 of 645) of non-recipients (P = .4). Use of routine prophylactic flucloxacillin did not significantly reduce incidence of post-MMC wound infection (odds ratio, 0.6; 95% confidence interval, 0-1.2).
  
  
  CONCLUSIONS
  When compared with no prophylactic flucloxacillin, routine prophylactic flucloxacillin does not significantly reduce the risk of post-MMC wound infection in a massive circumcision program.
authors.affiliation: Perinatal HIV Research Unit, University of the Witwatersrand, Soweto, South Africa. Electronic address: lebinal@phru.co.za.
authors.forename: Limakatso
authors.initials: L
authors.lastname: Lebina
authors.forename: Fatima
authors.initials: F
authors.lastname: Laher
authors.forename: Hillary
authors.initials: H
authors.lastname: Mukudu
authors.forename: Thandekile
authors.initials: T
authors.lastname: Essien
authors.forename: Kennedy
authors.initials: K
authors.lastname: Otwombe
authors.forename: Glenda
authors.initials: G
authors.lastname: Gray
authors.forename: Neil
authors.initials: N
authors.lastname: Martinson
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002944:Circumcision, Male / Q000009:adverse effects*; D005436:Floxacillin / Q000008:administration & dosage*; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D005436:Floxacillin
keywords: HIV; Infection prevention; MMC program; Medical male circumcision; Wound infections