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

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.

Timing of preoperative antibiotic prophylaxis in 54,552 patients and the risk of surgical site infection

“…Of the observational studies, 1 was a case control study, [16] 2 were retrospective cohorts, [17,18] and 11 were prospective cohorts. [4–6,19–26] Most studies included a variety of surgical procedures. Represented surgical procedures were gastrointestinal, orthopedic, vascular, traumatology gynecology, and cardiac surgery.…”

“…Only 1 study specified categories of SSI (superficial, deep, organ space) per timing category and reported a similar distribution across timing categories. [5] Four studies considered SSI as an infection occurring before discharge, [4,20,24] 1 before removal of stiches [26] and 9 within 30 days after surgery (or 1 year in the case of implantation of a foreign body). [5,6,16–18,21–23,25] Nine studies reported postoperative antibiotic continuation with a varying duration up to 48 hours.…”

“…[4–6,17,18,21–23,27] Five studies did not report on postoperative antibiotic regimen. [16,19,20,25,26] Four studies reported a re-dosing regimen within 4 hours after first administration, [6,17,25,26] 3 studies reported a procedure duration not requiring re-dosing, [20,22,23] 7 studies reported no information on re-dosing. [4,5,16,18,19,21,25,28] All but one study used fast infusing antibiotics such as cephalosporin with varying half times.…”

“…[4,5,16,18,19,21,25,28] All but one study used fast infusing antibiotics such as cephalosporin with varying half times. [4–6,16–20,22–26] One study used vancomycine. [21] Ten of the 14 studies reported odds ratios adjusted for confounding variables.…”

Risk of Acute Kidney Injury with Amikacin versus Gentamycin both in Combination with Metronidazole for Surgical Prophylaxis

“…This variation may be due to dose of aminoglycosides used. They used low dose of gentamycin (80 mg intravenously) or amikacin (500 mg intravenously) [13]. Aminoglycosides should be avoided in already existing nephrotoxic diseases and if given amikacin can be preferred over gentamycin.…”