Prophylactic antibiotics in amputation of the lower extremity for ischemia. A placebo-controlled, randomized trial of cefoxitin.

Antibiotic prophylaxis in lower-extremity amputations due to ischemia

“…Our choice of antibiotics was determined by the wish to use drugs that were effective against clostridia and, recognizing that the main bacteriological problem was Staphylococcus aureus, they should belong to the group of very stable betalactam antibiotics. The present study of 1-day treatment with cephalothin or methicillin showed results that are comparable to those of 1 day cefoxitin treatment, for which Sonne-Holm et al [17] reported 17% postoperative wound infections, and to 2-day treatment with amoxycillinclavulanic acid, for which Huzinga et al [11] reported 13% postoperative wound infections. Studies have shown that the administration of antibiotics immediately before the operation is effective in preventing inoculi from causing infection [2,3].…”

“…The types of antibiotics and the duration of treatment are often debated. Sonne-Holm et al [17] and B.M.M¢ller [12] showed good results with 1 day of treatment. In order to disturb the normal flora of the body as little as possible, a further criterion was that they should be narrow-spectrum antibiotics.…”

“…In order to disturb the normal flora of the body as little as possible, a further criterion was that they should be narrow-spectrum antibiotics. Sonne-Holm et al [17] concluded that a broad-spectrum antibiotic was imperative in prophylaxis. However, prophylaxis for longer than 3 days seems unnecessary [4,14].…”

Factors affecting wound healing after major amputation for vascular disease

“…Prophylactic antibiotic treatment reduces the frequency of wound infections after major amputations compared to no prophylaxis at all (Mdler and Krebs, 1985;Robbs and Ray, 1982;Sonne-Holm et al, 1985). In a randomised trial, prophylactic treatment with a broad-spectrum antibiotic (cefoxitin) lowered the frequency of infected wounds and reamputations more than placebo treatment (Sonne-Holm et al, 1985).…”

“…Furthermore, despite improvements in amputation techniques (Burgess et al, 1971;Jain et al, 1995;Persson, 1974;Robinson et al, 1982), and in the management of major amputations (Bunt et al, 1984;Sonne-Holm et al, 1985), the reamputation rate after major amputations has remained unchanged over the past 20 years ( Table 2). The reasons for the absence of any significant reduction of reamputation rate are unknown.…”