Colorectal Surgery: Short-Term Prophylaxis with Clindamycin Plus Aztreonam or Gentamicin

Rodolico, G; Puleo, Stefano; Blandino, G; Russello, Domenico; Amodeo, C; Latteri, Ferdinando; Veroux, G; Nicoletti, Giuseppe

doi:10.1093/clinids/13.supplement_7.s612

Cited by 8 publications

(3 citation statements)

References 9 publications

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“…Clindamycin plus gentamicin was less effective than clindamycin plus aztreonam. 109,132 The difference was not statistically significant when clindamycin plus gentamicin were compared with cefoxitin, gentamicin plus lincomycin, or gentamicin plus metronidazole. 32,89…”

Section: Clindamycinmentioning

confidence: 94%

“…Four trials compared aztreonam plus clindamycin with other antibiotics (Table 4). 25,50,109,132 Two very small trials compared aztreonam plus clindamycin with cefotetan 25 or ceftriaxone 50 and no significant differences were found. By pooling the results from two trials, 109,132 it was found that the rate of SWI in the aztreonam plus clindamycin group was significantly lower than that of the gentamicin plus clindamycin group (7.2% versus 13.6%, overall odds ratio = 0.51; 95% CI: 0.3, 0.87).…”

Section: Aztreonammentioning

confidence: 99%

See 1 more Smart Citation

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

Song¹,

Am²

1998

Health Technology Assessment

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This review evaluates the relative efficacy of antimicrobial prophylaxis in patients undergoing colorectal surgery where there is a high risk of surgical wound infection (SWI). Methods Data sources Literature searches of Medline, Embase and the Cochrane Controlled Trials Register were conducted to identify randomised controlled trials (RCTs) published between 1984 and 1995, which investigated antimicrobial prophylaxis in the prevention of postoperative wound infection in patients who had undergone colorectal surgery. Bibliographies of reviews and all identified trials were examined to locate additional studies. A sample of key journals was also handsearched. All languages were considered. Copies State how the article was located, e.g. name the database, handsearching. If an article is to have more than one record, only the first record should list the method of location, for any further records enter Repeat.

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Section: Clindamycinmentioning

confidence: 94%

Section: Aztreonammentioning

confidence: 99%

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

Song¹,

Am²

1998

Health Technology Assessment

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“…Since then the drug has been found to be effective in paediatric infections (Stutman 1991), including meningitis (Lentnek & Williams 1991), in infections in patients with cystic fibrosis, in osteomyelitis, and in peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). In addition aztreonam has been used as part of a prophylactic regimen, as an alternative to aminoglycosides, for various surgical procedures (Rodolico et al 1991). Pharmacokinetic data regarding the use of aztreonam in these patient groups have been collected and these data are presented here, updating the previous review (Mattie 1988).…”

Section: Discussionmentioning

confidence: 98%

Clinical Pharmacokinetics of Aztreonam

Mattie

1994

Clinical Pharmacokinetics

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Plasma concentrations of aztreonam follow a 2-compartment open model with a distribution half-life of 0.20 hours after intravenous injection. The volume of distribution at steady-state (Vss) after intravenous and intramuscular injection is about 0.16 L/kg (0.42 L/kg for free drug). After intramuscular injection, absorption is almost complete. Absorption after intraperitoneal administration in patients with peritonitis is 92%. Over a large dosage range, plasma concentrations increase dose proportionally. In healthy individuals, about 56% of the drug is plasma protein bound. Diffusion into tissues is generally slow, and the ratio between mean tissue and plasma aztreonam concentration seems to depend mainly on tissue composition. Aztreonam penetrates into cerebrospinal fluid (CSF) more rapidly in patients with inflamed meninges than in those with noninflamed meninges. Diffusion through the placenta is poor, as is diffusion into breastmilk. Aztreonam is predominantly eliminated by the kidney, partly by active tubular excretion. Extrarenal clearance appears to be through hepatic excretion. Metabolism occurs to a very limited extent. Total plasma clearance (CLp) in healthy adults is about 5.6 L/h and the terminal elimination half-life is 1.7 to 2.0 hours. CLp is similar in both children and adults when expressed as a function of bodyweight. However, in neonates, especially in low birthweight infants, CLp is lower. In various disease states, the Vss of aztreonam is not appreciably different from that found in healthy individuals. However, patients with low serum albumin levels (e.g. burn patients, critically ill patients and those with cirrhosis of the liver) generally have an increased volume of distribution. The elimination half-life of the drug is dependent on renal function.(ABSTRACT TRUNCATED AT 250 WORDS)

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Antimicrobial Prophylaxis for Surgical Wounds

Page

Bohnen²,

Fletcher³

et al. 1993

Arch Surg

463

261

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Prophylactic administration of antibiotics can decrease postoperative morbidity, shorten hospitalization, and reduce the overall costs attributable to infections. Principles of prophylaxis include providing effective levels of antibiotics in the decisive interval, and, in most instances, limiting the course to intraoperative coverage only. Use in The National Research Council clean contaminated operations is appropriate and, in many instances, has been proven beneficial. Antibiotic prophylaxis is also indicated for clean operations, such as those involved with insertion of prosthetic devices, that are associated with low infection risk and high morbidity. Extension of antibiotic prophylaxis to other categories of clean wounds should be limited to patients with two or more risk factors established by criteria in the study of the efficacy of nosocomial infection control (SENIC) because the baseline infection rate in these patients is high enough to justify their use. Cefazolin (or cefoxitin when anaerobic coverage is necessary) remains the mainstay of prophylactic therapy. Selection of an alternate agent should be based on specific contraindications, local infection control surveillance data, and the results of clinical trials. Newer criteria for determining the risk of "site infection" (wound and intracavitary) are in evolution and may lead to modification of these recommendations over the next several years.

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Colorectal Surgery: Short-Term Prophylaxis with Clindamycin Plus Aztreonam or Gentamicin

Cited by 8 publications

References 9 publications

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

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

Clinical Pharmacokinetics of Aztreonam

Antimicrobial Prophylaxis for Surgical Wounds

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