A randomized trial of one versus three doses of Augmentin as wound prophylaxis in at-risk abdominal surgery

Abstract

Summary:In a randomized prospective trial of prophylactic antibiotics in at-risk abdominal surgery, one dose ofintravenous Augmentin (amoxycillin 250 mg and clavulanic acid 125 mg) on induction has been compared with three 8 hourly doses in 900 patients. Wound infection rates which included minor and delayed infections were very similar in those given one dose: 48/449 (10.7%) compared with those given three doses: 49/451 (10.9%) 95% confidence limits -4.25% + 3.9%.There were more septic and sepsis-related deaths in those patients given one dose (14 deaths) than in those given three doses (7 deaths) P > 0.1 95% CL -0.4% + 3.0%. However, there were more very elderly patients in the one dose group: 64% of the deaths were aged over 80 and all but one had an emergency operation. There was no difference in the other outcome measures studied which included non-fatal deep sepsis, length of postoperative hospital stay, duration of postoperative fever or the use of antibiotics for postoperative infection.One dose of a suitable intravenous antibiotic gives prophylaxis against wound infection in at-risk abdominal surgery which is at least as effective as multiple doses. However, there may be a risk of overwhelming systemic sepsis in very elderly patients having emergency surgery.

Clinical practice guidelines for antimicrobial prophylaxis in surgery

“…No differences in efficacy between first-and secondgeneration cephalosporins were found. Amoxicillin-clavulanate 279,282,283,299 and ciprofloxacin 269,300 were also evaluated with similar results. Relatively few studies have compared the efficacy of different agents in reducing postoperative infection rates.…”

“…256,[279][280][281][282][283][284]288,290,297 The available data indicate that single-dose and multiple-dose regimens are similarly effective. Three studies compared single-and multiple-dose regimens of cefamandole, 294 amoxicillin-cluvulanate, 299 and ampicillin-sulbactam and cefazolin. 253 There were no significant differences in SSI rates.…”

Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery

“…No differences in efficacy between first-and second-generation cephalosporins were SURGICAL PROPHYLAXIS GUIDELINES found. Amoxicillin-clavulanate [279,282,283,299] and ciprofloxacin [269,300] were also evaluated with similar results. Relatively few studies have compared the efficacy of different agents in reducing postoperative infection rates.…”

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

“…Seven trials did not find differences in the SWI rate between co-amoxiclav arms and other antibiotics such as cephradine plus metronidazole, 145 gentamicin plus metronidazole, 61 mezlocillin alone or plus metronidazole, 87,100 and cefotetan. 19 Bates and co-workers 23 compared a single dose of co-amoxiclav with three doses of co-amoxiclav. The difference in the rate of SWI was not statistically significant (odds ratio = 1.41; 95% CI: 0.71, 2.82).…”

“…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).…”