Double-blind comparison of cefazolin and ceftizoxime for prophylaxis against infections following elective biliary tract surgery

Abstract

Antibiotics have been shown to reduce the incidence of wound infections after elective biliary tract procedures. Cefazolin and cefoxitin are among the agents most commonly promoted for this purpose. Cefoxitin has been substituted with ceftizoxime in many institutions; however, the role of ceftizoxime as a prophylactic agent in this setting has not been determined. To assess the comparative prophylactic efficacies of cefazolin and ceftizoxime in biliary tract surgery, we conducted a double-blind, randomized prospective clinical trial in a tertiary-care teaching hospital. Adult patients were randomized to one of two treatment groups and received a 30-min preoperative dose of study drug and as many as two postoperative doses at 12 and 24 h, depending on hospitalization status. Cefazolin and ceftizoxime were given as 1,000-mg doses. Patients with infections, those receiving prior antibiotics, or those with beta-lactam allergies were excluded. Over the 19-month study tenure, 167 patients were enrolled. Seventeen patients were excluded from analysis because of protocol violations. Of the 150 evaluable patients (72 and 78 receiving cefazolin and ceftizoxime doses, respectively), there was no significant difference among groups regarding sex, age, weight, preoperative Apache II score, baseline chemistry, and hematological parameters. Groups were also equivalent regarding the surgeon, type of procedure, characteristics (blood loss, drains, organ injury, and complications), and duration of hospital stay (mean, 5.6 versus 4.3 days [P = 0.31]). No clinical evidence of infection (7-day hospital stay and 30-day follow-up) was identified in 93% of cefazolin and 92% of ceftizoxime patients (P = 1.0). Microbiological confirmation was found in only 18% of primary-site infections. In conclusion, cefazolin and ceftizoxime appear to be equivalent for the prevention of infection in biliary tract surgery with the dosage regimens studied.

Monitoring of Antimicrobial Prophylaxis in General Surgery

“…No difference was evident during the two periods of study, before and after rebuilding of the structure. Such data are consistent with what is reported in the literature 4,5,6,15,16,17 . Even though our incidence of infections in clean and clean-contaminated surgery is fairly good, we hope to improve that reported for contaminated surgery.…”

Clinical practice guidelines for antimicrobial prophylaxis in surgery

“…Firstgeneration, 307 cephalosporins have been studied more extensively than other antimicrobials. Limited data are available for ampicillin with gentamicin, 355 piperacillin, 356 amoxicillinclavulanate, 305,338,351,354 ciprofloxacin, 320,333,352,357 and cephalosporins or penicillins alone or in combination with metronidazole, gentamicin, or b o t h m e t ron i d a zo l e a n d gentamicin. 308 Several studies have compared first-generation cephalosporins with second-or third-generation agents.…”

“…308 Several studies have compared first-generation cephalosporins with second-or third-generation agents. 315,336,338,[344][345][346][347]353,358 With one exception, 347 there was no significant difference in efficacy among agents. Other studies found no significant differences in efficacy between ampicillin and cefamandole, 335 ciprofloxacin and ceftriaxone, 333 amoxicillin-clavulanate and cefotaxime, 354 amoxicillin-clavulanate and cefamandole, 351 ceftriaxone and ceftazidime, 321 and oral and i.v.…”

“…The organisms most commonly associated with infection after biliary tract procedures include E. coli, Klebsiella species, and enterococci; less frequently, other gram-negative organisms, streptococci, and staphylococci are isolated. 305,306,312,315,316,318,319,321,326,[328][329][330][331][332][333][334][335][336][337][338] Anaerobes are occasionally reported, most commonly Clostridium species.…”

Antibiotic Prophylaxis and Treatment of Surgical Abdominal Sepsis

“…Endoscopic percutaneous gastrostomy is an operative procedure at high risk of abdominal sepsis: a single preoperative dose of cefotaxime or piperacillin-tazobactam or ceftriaxone appears effective, but not cefazolin 11-13 . Many studies have been performed on video-laparoscopic (VLS) cholecystectomy. The procedure is less traumatic than open cholecystectomy and has a minimal incidence of surgical infections (1.8% vs 12.9% in a retrospective study) 14 , which may decline to zero as shown in a double-blind randomized study using cefazolin vs ceftizoxime pre-and post-operatively, 12 and 24 hours after surgery 15 . Another study using cefazolin did not show a significant difference between study and control group.…”