Drugs

, Volume 35, Supplement 2, pp 100–105 | Cite as

Preventative Antibiotics for Penetrating Abdominal Trauma — Single Agent or Combination Therapy?

  • Brack A. Bivins
  • Larry Crots
  • Victor J. Sorensen
  • Farouck N. Obeid
  • H. Mathilda Horst
Section 3: Newer Experiences with Cefotaxime in Prophylaxis

Summary

In this open, prospective, comparative study, 75 patients who sustained penetrating abdominal trauma were randomised to receive 1 of 3 antibiotic regimens preoperatively and for 3 to 5 days postoperatively. Group I received cefotaxime 2g 8-hourly, group II received cefoxitin 2g 6-hourly and group III received clindamycin (900mg 8-hourly) and gentamicin 3 to 5 mg/kg/day in divided doses 8-hourly. The 3 groups were not statistically different in terms of age, sex, severity of injury, number of organs injured, colon injuries, shock, blood transfusions or positive intra-operative cultures. Septic complications occurred in 8% of patients in group I, in 4% of group II patients and in 8% of group III patients. Cefotaxime was the least costly regimen, followed by cefoxitin, then clindamycin and gentamicin.

It may be concluded that single agent therapy with a broad spectrum cephalosporin is preferable to combination therapy on the basis of equivalent effectiveness, less toxicity and lower costs.

Keywords

Gentamicin Cefotaxime Clindamycin Cefoxitin Abdominal Trauma 

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References

  1. Bivins BA. Antibiotic considerations in trauma surgery. Infections in Surgery 6 (Suppl.): 35–39, 1987Google Scholar
  2. Bessey PQ, Watters JM, Aoke TT, Wilmore DW. Combined hormonal infusion simulates the metabolic response to injury. Annals of Surgery 200: 264–281, 1984PubMedCrossRefGoogle Scholar
  3. Crenshaw C, Glanges E, Webber C, McReynolds DB. A prospective random study of a single agent versus combination antibiotics as therapy in penetrating injuries of the abdomen. Surgery, Gynecology and Obstetrics 156: 289–294, 1983PubMedGoogle Scholar
  4. Crots LD, Obeid FN, Horst HM, Bivins BA. Twice-daily moxalactam versus clindamycin/gentamicin in patients with penetrating abdominal trauma. Clinical Pharmacy 4: 316–320, 1985PubMedGoogle Scholar
  5. Dahlgren B, Berlin R, Brandberg A. Bactériologie findings in the first 12 hours following experimental missile trauma. Acta Chirurgica Scandinavica 147: 513–518, 1981PubMedGoogle Scholar
  6. Dougherty SH, Flohr AB, Simmons RL. Breakthrough enterococcal septicemia in surgical patients. Archives of Surgery 118: 232–238, 1983PubMedCrossRefGoogle Scholar
  7. Heseltine PNR, Berne TV, Yellin AE. The efficacy of cefoxitin vs clindamycin/gentamicin in surgically treated stab wounds of the bowel. Journal of Trauma 26: 241–245, 1986PubMedCrossRefGoogle Scholar
  8. Hofstetter SR, Pachter HL, Bailey AA, Coppa GF. A prospective comparison of two regimens of prophylactic antibiotics in abdominal trauma: cefoxitin versus triple drug. Journal of Trauma 24: 307–310, 1984PubMedCrossRefGoogle Scholar
  9. Jones RC. Antibiotics in trauma. In Condon & Gorbach (Eds) Surgical infections: selective antibiotic therapy. Williams & Wilkins, Baltimore, 1981Google Scholar
  10. Jones RC, Thal ER, Johnson NA, Golihar LN. Evaluation of antibiotic therapy following penetrating abdominal trauma. Annals of Surgery 201: 576–585, 1985PubMedCrossRefGoogle Scholar
  11. Moore FA, Moore EE, Mill MR. Preoperative antibiotics for abdominal gunshot wounds: a prospective, randomized study. American Journal of Surgery 146: 762–765, 1983PubMedCrossRefGoogle Scholar
  12. Nichols RL, Smith JW, Klein DB, Trunkey DD, Cooper RH, et al. Risk of infection after penetrating abdominal trauma. New England Journal of Medicine 311: 1065–1070, 1984PubMedCrossRefGoogle Scholar
  13. Oreskovich MR, Dellinger EP, Lennard ES, Wertz M, Carrico CJ, et al. Duration of preventative antibiotic administration for penetrating abdominal trauma. Archives of Surgery 117: 200–204, 1982PubMedCrossRefGoogle Scholar
  14. Rapp RP, Bannon CL, Bivins BA. The influence of dose frequency and agent toxicity on the cost of parenteral antibiotic therapy. Drug Intelligence and Clinical Pharmacy 16: 935–938, 1982PubMedGoogle Scholar
  15. Schentag JJ, Wels PB, Reitberg DP, Walczak P, Hawkins Van Tyle J, et al. A randomized clinical trial of moxalactam alone versus tobramycin plus clindamycin in abdominal sepsis. Annals of Surgery 198: 35–14, 1983PubMedCrossRefGoogle Scholar
  16. Stone HH, Strom PR, Fabian TC, Dunlop WE. Third-generation cephalosporins for polymicrobial surgical sepsis. Archives of Surgery 118: 193–200, 1983PubMedCrossRefGoogle Scholar
  17. Thadepalli H. Principles and practice of antibiotic therapy for post-traumatic abdominal injuries. Surgery, Gynecology and Obstetrics 148: 937–951, 1979PubMedGoogle Scholar
  18. Twyman DL, Bivins BA, Young AB. Failure of protein conservation in brain-injured patients. Surgical Forum 36: 515–517, 1985Google Scholar

Copyright information

© ADIS Press Limited 1988

Authors and Affiliations

  • Brack A. Bivins
    • 1
  • Larry Crots
    • 1
  • Victor J. Sorensen
    • 1
  • Farouck N. Obeid
    • 1
  • H. Mathilda Horst
    • 1
  1. 1.Division of Trauma SurgeryHenry Ford HospitalDetroitUSA

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