A comparison between single and double dose intravenous timentin for the prophylaxis of wound infection in elective colorectal surgery

Abstract

A prospective, randomized, single-blind, controlled clinical trial was undertaken to determine whether two doses of systemic Timentin provided superior prophylaxis against postoperative sepsis in elective colorectal surgery compared with a single dose of the same antibiotic. Timentin, a combination of ticarcillin and clavulanic acid was administered intravenously (3.1 g) at the commencement of operation to all patients, and this was repeated after 2 hours in those patients randomized to receive a second dose. The wound infection rate was 11 percent in the 143 patients completing follow-up and receiving a single dose, and 13 percent in the 128 patients receiving two doses of Timentin (P greater than 0.05). The rates of postoperative septicemia 3 vs. 4 percent and intra-abdominal abscess 5 vs. 8 percent were similar. Multivariate analysis of the factors likely to affect postoperative would infection rate demonstrated an association with the type of hospital, public or private, wound infection rate 16 and 6 percent, respectively (P less than 0.01), and the surgeon group defined by the number of patients contributed greater than 25 or less than 25, wound infection rate 6 and 18 percent, respectively (P less than 0.05). We concluded that a single dose of intravenous Timentin was as effective as two doses for prophylaxis against surgical infection and that the surgeon group and the hospital in which the operation took place were statistically significant predictors of postoperative wound infection.

The Significance of the Intraoperative Repeated Dosing of Antimicrobials for Preventing Surgical Wound Infection in Colorectal Surgery

“…Cuthbertson et al performed a randomized controlled trial comparing single and double doses of ticarcillin/ clavulanic acid in elective colorectal surgery. 9 The first dose was administered just before the skin incision and the second dose 2 h later. There was no significant difference in the wound infection rate between the two groups.…”

Antimicrobial prophylaxis in colorectal surgery: a systematic review of randomised controlled trials.

“…157 Several trials that compared a single dose with multiple doses reported the duration of operation. The average duration of operation was 92 minutes in the trial by Carr and co-workers, 34 135 minutes in Cuthbertson's trial 40 and 116 minutes (range: 20-270) in Wenzel's trial. 154 In the trial by Jensen and co-workers, the proportion of patients whose operation lasted longer than 180 minutes was 29%.…”

“…None of these trials found a significant difference in postoperative SWI between single-dose and multiple-dose regimens. The antibiotics that were investigated in these trials were cefoxitin, 38,81 cefuroxime plus metronidazole, 14 metronidazole, 34 ampicillin plus metronidazole, 69,74 co-amoxiclav, 23 latamoxef, 60 mezlocillin plus metronidazole, 27,58,98 ticarcillin/clavulanic acid, 40 cefotaxime plus metronidazole, 81 gentamicin plus ornidazole, 154 piperacillin plus tinidazole, 148 doxycycline, 54 and cefotaxime. 88 When the results from these 17 trials were pooled, there was no significant difference between the single-and multiple-dose groups (10.6% versus 9.7%; odds ratio = 1.17; 95% CI: 0.89, 1.54).…”

A multivariate analysis of the factors associated with wound infection after colorectal surgery

“…The incidence of wound infection in clinical trials of patients undergoing colorectal surgery varies between 9.5% and 22% [ 4–8]. The reported rates in non‐trial patients undergoing elective colorectal surgery varies from 5% to 7.5% [ 9].…”