Intraincisional antibiotics in laparotomy wounds |
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Authors: | Flemming Moesgaard MD Dr Mogens Lykkegaard-Nielsen MD PhD Tage Justesen MD |
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Institution: | (1) Department of Surgical Gastroenterology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark;(2) 31 Sofievej, DK-2900 Hellerup, Denmark |
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Abstract: | Concentrations of ampicillin after intraincisional instillation in laparotomy wounds were measured in ten patients undergoing
appendectomy. Ampicillin, 1 gm, was instilled under the fascia and 1 gm in the subcutaneous space during wound closure. Wound
secretion was collected every two hours during the first 24 postoperative hours by cannulation of a fine perforated drain
placed in the subcutaneous space. Ampicillin was determined by a disk diffusion method. During the first eight hours the median
concentration of ampicillin in wound secretion exceeded 1000 microgram/ml; 14 hours and 20 hours after wound closure the median
concentrations were 73 and 14 microgram/ml, respectively. The effect of ampicillin in high concentrations on “resistant” strains
ofBacteroides fragilis was demonstrated in anin vitro experiment. It is concluded that in colorectal surgery the effect on wound sepsis of intraincisional antibiotics as an addition
to systemic antibiotic prophylaxis should be evaluated in a clinical trial. |
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Keywords: | Intraincisional antibiotics Ampicillin Wound sepsis |
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