Randomized, double-blind comparison of the efficacies, costs, and vaginal flora alterations with single-dose ceftriaxone and multidose cefazolin prophylaxis in vaginal hysterectomy

Abstract

We could not detect a difference between a single l-g dose of ceftriaxone and multidose cefazolin for infection prophylaxis in patients undergoing a vaginal hysterectomy. However, the total acquisition, preparation, and administration costs were greater for the ceftriaxone regimen than they were for the cefazolin regimen. Cefazolin should therefore remain the drug of choice for infection prophylaxis in uncomplicated vaginal hysterectomies.

Urinary tract infections after pelvic floor gynecological surgery: prevalence and effect of antimicrobial prophylaxis. A systematic review

“…This finding was explained by the fact that ceftriaxone compared to cefuroxime has a longer half-life leading to prolonged exposure to the drug [12]. On the other hand, Stiver et al did not find a statistically significant difference regarding development of UTI between patients undergoing vaginal hysterectomy receiving single-dose ceftriaxone and multidose cefazolin prophylaxis [13]. Also, Van der Linden et al found no difference in UTI rates in patients undergoing vaginal hysterectomy with or without colporrhaphy and receiving amoxicillin/clavulanate versus cefuroxime plus metronidazole [14].…”

“…Among them, age, obesity, and various underlying diseases are of crucial importance. Examples are neurogenic bladder, cardiovascular disease, and diabetes mellitus [8,13]. Preexisting UTIs may also evolve to recurrent UTIs after pelvic floor operations [12,19].…”

A randomized controlled trial comparing ceftriaxone with cefazolin for antibiotic prophylaxis in abdominal hysterectomy

“…Stiver et al [10] compared 1 preoperative 1‐g dose of ceftriaxone with 1 preoperative and 3 postoperative 1‐g doses of cefazolin among women undergoing elective vaginal hysterectomy. The infection rate did not differ significantly between the cefazolin group (6/73, 8.2%) and the ceftriaxone group (9/65, 13.8%).…”

Single dose ceftriaxone versus single dose cefuroxime plus metronidazole for preventing febrile morbidity and urinary tract infection in vaginal hysterectomy

“…A limited num ber of postoperative trials have studied single dose regimens. Mostly one dose was compared with three or four doses of the same or another comparable drug, often cefazolin [3], Ceftriaxone has been compared with multidose cefazolin and no difference in efficacy or se lection of resistant isolates was found [3,7]. The authors found that the total costs for ceftriaxone were greater than for cefazolin and this led in 1991 to the recommen dation that cefazolin should remain the drug o f choice for prophylaxis o f infection in uncomplicated vaginal hysterectomy [3].…”

“…The authors found that the total costs for ceftriaxone were greater than for cefazolin and this led in 1991 to the recommen dation that cefazolin should remain the drug o f choice for prophylaxis o f infection in uncomplicated vaginal hysterectomy [3]. Stiver et al [7] found 8% febrile mor bidity in 65 patients for ceftriaxone. In our study we found 5% febrile morbidity in 112 patients on ceftriax one.…”