Antibiotic prophylaxis for abdominal hysterectomy

Three different regimens of antibiotic treatment have been employed in order to evaluate their efficacy as a profilaxis for abdominal hysterectomy. Two short term administrations (Cephtriaxone and Cephamandole plus Tobramycine) and a conventional full dose treatment (Cephazoline) have been compared over a group of homogeneous patients. No significant differences, except a reduction in postoperative time spent in hospital, have been found among the groups. A reduction in urinary tract infection has also been reported with a single-dose antibiotic prophylaxis.     

Antibiotic prophylaxis for radical abdominal hysterectomy

Records of 35 patients with cervical cancer Stage IB operated with radical abdominal hysterectomy and pelvic lymphadenectomy were surveyed retrospectively for incidence of febrile morbidity and site-related infections. Febrile morbidity was observed in 6 patients (17%). No surgical site-related infections were observed. It is concluded that radical abdominal hysterectomy in our hospital does not carry any significant risk of postoperative site-related infections and that prophylactic antibiotics cannot be recommended.     

Antibiotic prophylaxis on treatment outcome after gynecologic surgery

The aim of our study is to estimate advantages and disadvantages of some antibacterial drugs which were used for prevention from infections in the early postoperative period. Our study is retrospective and involved all women which were undergoing different operations in department of gynaecology for the period January 2000 until June 2004. Due to a large number of patients and long period of time which were evaluated our study shows assume data for efficacy of different antibacterial drugs and drug combination when we using them for prevention. It is very interesting for the authors result about relationship between price-efficacy-durance ot hospital being.     

Antibiotic prophylaxis of infective complications after cesarean section. Our experience

BACKGROUND: The efficacy of a single dose of antibiotic vs multiple doses of the same drug, in reducing maternal infections following the cesarean section, is evaluated. METHODS: A total of 206 pregnant women undergoing elective or emergency cesarean section from 1st June 1998 to 30 June 1999, at the Department of Obstetrics and Gynecology of the University of L'Aquila, were included in a randomized study to compare the efficacy of prophylaxis with a single dose of piperacillin sodium (2 g i.v. after the umbilical cord clamping; group A) vs triple doses of the same antibiotic (2 g i.v. at 6 hourly intervals, beginning from the umbilical cord clamping; group B). RESULTS: The incidence of infective morbidity in group A was 7.3%, with a 2% wound infections, 1% urinary infections and 4.16% febrile morbidity. The incidence of infective morbidity in group B was not much higher (9%), with 2.7% wound infections, 1.8% urinary infections and 4.5% febrile morbidity. CONCLUSIONS: In order to obtain a useful antibiotic prophylaxis in cesarean sections, the single-dose seems to be preferable to the multiple-doses, since the single-dose not only has equal efficacy, but also less cost, smaller risk of super-infections by resistant organisms and it involves smaller care from the-medical and nursing staff.     

Antibiotic prophylaxis at Cesarean delivery

OBJECTIVE: Our aim was to compare the efficacy of ampicillin, cefotetan, and ampicillin/sulbactam in the prevention of post-Cesarean endomyometritis. METHODS: Consenting patients undergoing Cesarean delivery at the University of Louisville Hospital were enrolled in a prospective, double-blinded randomization to receive either ampicillin/sulbactam (Group 1), cefotetan (Group 2), or ampicillin (Group 3) single dose antibiotic prophylaxis following umbilical cord clamping. The primary outcome variable was the frequency of endomyometritis in the respective groups. RESULTS: Among 301 randomized patients, outcome data was available for 298 patients. Fourteen patients (4.7%), all of whom underwent non-elective Cesarean delivery, developed endomyometritis. The frequency of endomyometritis was not different among groups: Group 1, 4/101 (4%); Group 2, 4/96 (4.2%); and Group 3, 6/101 (5.9%). Wound infections were infrequently observed 4/298 (1.3%) without significant differences among groups. Stepwise discriminative analysis identified only last cervical dilatation as a significant predictor of endomyometritis (P = 0.006). CONCLUSION: Post-Cesarean endomyometritis occurs infrequently following single dose antibiotic prophylaxis after umbilical cord clamping. An advantage of broader spectrum antibiotics over ampicillin was not demonstrated.     

Antibiotic prophylaxis at cesarean delivery

Objective: Our aim was to compare the efficacy of ampicillin, cefotetan, and ampicillin/sulbactam in the prevention of post-Cesarean endomyometritis.

Methods: Consenting patients undergoing Cesarean delivery at the University of Louisville Hospital were enrolled in a prospective, double-blinded randomization to receive either ampicillin/sulbactam (Group 1), cefotetan (Group 2), or ampicillin (Group 3) single dose antibiotic prophylaxis following umbilical cord clamping. The primary outcome variable was the frequency of endomyometritis in the respective groups.

Results: Among 301 randomized patients, outcome data was available for 298 patients. Fourteen patients (4.7%), all of whom underwent non-elective Cesarean delivery, developed endomyometritis. The frequency of endomyometritis was not different among groups: Group 1, 4/101 (4%); Group 2, 4/96 (4.2%); and Group 3, 6/101 (5.9%). Wound infections were infrequently observed 4/298 (1.3%) without significant differences among groups. Stepwise discriminative analysis identified only last cervical dilatation as a significant predictor of endomyometritis (P = 0.006).

Conclusion: Post-Cesarean endomyometritis occurs infrequently following single dose antibiotic prophylaxis after umbilical cord clamping. An advantage of broader spectrum antibiotics over ampicillin was not demonstrated.     

Antibiotic prophylaxis after operative vaginal birth: the ANODE randomized controlled trial

All forms of operative birth are associated with a higher risk of infection compared to unassisted vaginal birth. Evidence of benefit of antibiotic prophylaxis at caesarean birth is well established, but prior to the ANODE trial, evidence of effectiveness of antibiotic prophylaxis after assisted vaginal birth was lacking. The ANODE trial randomized 3427 women to a single intravenous dose of co-amoxiclav or placebo immediately after assisted vaginal birth and showed an almost halving of the rate of confirmed or suspected infection, from 19% in the antibiotic group to 11% in the placebo group. Royal College of Obstetricians and Gynaecologists guidance has now been changed to recommend routine use of a single dose prophylactic antibiotic after operative vaginal birth on the basis of this clear evidence of benefit.     

Antibiotic prophylaxis for selected gynecologic surgeries

BackgroundAntibiotic prophylaxis for surgery is commonly used and is recommended by multiple organizations.ObjectiveTo critically review gynecology-specific data regarding surgical antibiotic prophylaxis in selected benign gynecologic surgeries.Search strategyMEDLINE and Cochrane databases were searched from inception to July 2010.Selection criteriaRandomized controlled trials of benign vaginal, cervical, transcervical, abdominal, or laparoscopic procedures other than hysterectomy comparing prophylactic antibiotic use with placebo or with another antibiotic. Outcomes of interest were postoperative infections, additional treatments, and adverse events.Data collection and analysisIn total, 19 trials met the inclusion criteria. Studies were individually assessed for methodologic quality, then grouped by procedure and evaluated for evidence quality.Main resultsThere was no difference in infectious outcome for loop electrosurgical excision, hysteroscopic ablation, or laparoscopy, although evidence quality was poor. Fair evidence supports antibiotic prophylaxis for suction curettage or laparotomy. There were insufficient data regarding vaginal surgery prophylaxis.ConclusionAntibiotic prophylaxis may be beneficial in first-trimester suction curettage and laparotomy. No advantage was found for loop electrosurgical excision, hysteroscopy, or laparoscopic gynecologic surgery. Newer procedures and vaginal surgery lack research and merit study.     

Antibiotic prophylaxis in surgery by vaginal route

The authors study 56 cases of vaginal hysterectomy divided in two groups of 28, one of which received antibiotics prophylaxis at the time of the procedure. The incidences on post-operative fever, infection of the vaginal section and the number of urinary infections are significantly much lower in the group treated.     

Cost-benefit analysis of cephradine and mezlocillin prophylaxis for abdominal and vaginal hysterectomy

Summary. Four hundred patients (300 abdominal and 100 vaginal hysterectomies) were randomized to receive a single, pre-operative intravenous injection of saline (placebo), 2 g cephradine or 5 g mezlocillin. The frequency of wound and pelvic infections was significantly reduced (P<0.05, χ²- or Fisher's exact test) in the abdominal hysterectomy patients who received cephradine (16% vs 23% mezlocillin, 29% placebo) and in the vaginal hysterectomy patients who received cephradine or mezlocillin (0% mezlocillin, 6% cephradine vs 27% placebo). These results are similar to those of previous studies and suggest that prophylaxis is more effective for vaginal than for abdominal hysterectomy. However, a cost-benefit analysis supported the opposite conclusion. Cephradine prophylaxis for abdominal hysterectomy resulted in cost savings to the hospital and the community health services with measurable benefits to the patient. In contrast, cephradine or mezlocillin prophylaxis for vaginal hysterectomy resulted in increased costs to the hospital, no savings to community services and no significant benefit to the patient. We conclude that cost-benefit analysis provided valuable additional information to the conventional, statistical analysis of wound or pelvic infection rates.     

Cost-benefit analysis of cephradine and mezlocillin prophylaxis for abdominal and vaginal hysterectomy

Four hundred patients (300 abdominal and 100 vaginal hysterectomies) were randomized to receive a single, pre-operative intravenous injection of saline (placebo), 2 g cephradine or 5 g mezlocillin. The frequency of wound and pelvic infections was significantly reduced (P less than 0.05, chi 2- or Fisher's exact test) in the abdominal hysterectomy patients who received cephradine (16% vs 23% mezlocillin, 29% placebo) and in the vaginal hysterectomy patients who received cephradine or mezlocillin (0% mezlocillin, 6% cephradine vs 27% placebo). These results are similar to those of previous studies and suggest that prophylaxis is more effective for vaginal than for abdominal hysterectomy. However, a cost-benefit analysis supported the opposite conclusion. Cephradine prophylaxis for abdominal hysterectomy resulted in cost savings to the hospital and the community health services with measurable benefits to the patient. In contrast, cephradine or mezlocillin prophylaxis for vaginal hysterectomy resulted in increased costs to the hospital, no savings to community services and no significant benefit to the patient. We conclude that cost-benefit analysis provided valuable additional information to the conventional, statistical analysis of wound or pelvic infection rates.     

Antibiotic prophylaxis: is there a difference?

Seven antibiotics, administered in 10 different regimens for prophylaxis, were randomly assigned to 1580 patients who were delivered by cesarean section. Cefazolin 1 gm, administered for three doses, served as the control group. Cefazolin 1 gm, cefazolin 2 gm, cefoxitin 1 gm, cefoxitin 2 gm, cefonicid 1 gm, cefotetan 1 gm, ceftizoxime 1 gm, ampicillin 2 gm, and piperacillin 4 gm were all administered in a single dose. Four antibiotics proved to be superior in preventing postpartum endometritis: ampicillin 2 gm (p = 0.03), cefazolin 2 gm (p = 0.005), piperacillin 4 gm (p = 0.0007), and cefotetan 1 gm (p = 0.0001). Single-dose cephalosporin antibiotic prophylaxis was found to result in approximately a twofold increase in Enterococcus faecalis colonization of the vagina (p less than 0.01). This may be significant in patients in whom postpartum endometritis develops and who have failure of initial treatment with a broad-spectrum cephalosporin, e.g., cefoxitin or cefotetan, or a combination such as clindamycin or metronidazole plus an aminoglycoside. Rupture of amniotic membranes for a half hour or more was associated with an increased risk for postpartum endometritis. The use of internal fetal monitoring was associated with an increased risk of soft tissue pelvic infection.