Comparison of three prophylactic antibiotic regimens in clean-contaminated head and neck surgery

Abstract

Background Although appropriate perioperative antibiotic prophylaxis has significantly reduced wound infection rates in clean‐contaminated head and neck surgical procedures, controversy still remains regarding the optimal antibiotic regimen. Methods In this prospective, double‐blind clinical trial, 159 patients were randomized to receive amoxicillin‐clavulanate, clindamycin plus gentamicin, or cefazolin intravenously up to ½ hour before surgery and at 8‐hour intervals for an additional three doses. Results An overall wound infection rate of 23% was observed. Thirteen (22.8%) infections occurred in the amoxicillin‐clavulanate‐treated group, 11 (21.2%) in the clindamycin plus gentamicin‐treated group, and 13 (26%) in the cefazolin‐treated group, which was not statistically significant. Only prior medical illnesses, such as chronic obstructive pulmonary disease and diabetes mellitus, correlated with an increased wound infection rate (p = 0.018). Conclusions Amoxicillin‐clavulanate, clindamycin plus gentamicin, and cefazolin seem to have similar efficacy when administered prophylactically in clean‐contaminated head and neck surgical procedures. © 1997 John Wiley & Sons, Inc. Head Neck 19: 188–193, 1997.

Prognostic significance of wound infections following major head and neck cancer surgery: an open non-comparative prospective study

“…Cole et al [5] found that the presence of laryngectomy stoma is also significant. It has been stated that the existence of a stoma preoperatively may lead to colonization of secretions and infection [30]. Moreover the presence of a stoma may have led to colonization of the wound and favoured infection persistence, with selection of resistant pathogens (infection on foreign body).…”

“…Many studies have shown that the postoperative hospital stay is dramatically increased [18,23,30,34]. Alterations in quality of life and poor cosmetic results are evident, but no study has been carried out to analyse specifically these subjective parameters.…”

Antibiotic prophylaxis in clean-contaminated head and neck oncological surgery

“…The Antimicrobial Agents Committee of the Surgical Infection Society of the United States of America recommends cefazolin for prophylaxis in clean-contaminated head and neck surgery, although it has Gram-positive aerobic coverage only (Rodrigo et al, 1997). To date, it remains the mainstay for prophylaxis in cleancontaminated head and neck surgery (Shinagawa et al, 2003;Rodrigo et al, 2004).…”

Prevention and treatment of postsurgical head and neck infections

“…Several prospective, randomized, double-blinded studies have been conducted in attempts to determine the optimal regimen of antimicrobial prophylaxis for clean-contaminated head and neck surgery [7,8,21,[52][53][54]. The specific antimicrobial agent and the duration of prophylaxis have been examined.…”

“…Similar efforts to determine the pathogenicity of gramnegative isolates from wound culture have been less clear. Although one study was able to demonstrate a reduction in the incidence of wound infection by adding gram-negative coverage to the prophylactic antibiotic regimen [56], other studies have not [52,53,59]. Current consensus is that in most cases, isolation of gram-negative aerobes from wound culture represents colonization.…”