The third-generation cephalosporin ...

The third-generation cephalosporin antibiotics ceftriaxone and cefotaxime are widely used for prophylaxis in abdominal surgery the pair are active against a wide range of gram-positive and gram-negative organisms and have small in number side effects. The agents differ in splendor and pharmacologic properties; 1 g of intravenous ceftriaxone has an average wholesale price of $46 compared with $12 for 1 g of intravenous cefotaxime. Woodfield and colleagues compared the prophylactic efficacy of these agents in more than 1000 patients undergoing abdominal surgery

They studied 1013 adult patients admitted to a general surgery unit in strange Zealand for acute or elective abdominal surgery The patients were randomly assigned to prophylaxis with either agent after stratification to make secure that patients with particularly high risk of infection (eg colorectal resections) were equally distributed in the pair treatment groups. All patients received 1 g of the touchstone agent intravenously at the induction of anesthesia, and patients in the highest risk collection also were given 500 mg of metronidazole intravenously. Surgeon and staff did not know the patients' treatment allocations. Patients were followed for at least 30 days after surgery The major issue measured was wound infection with pus formation or cellulitis, and minor last points were yeast superinfection, reaching far down peritoneal infection, chest infection, urinary tract infection, intravenous line sepsis, and other infections as it was as septicemia, infection of drain sites, and diarrhea resulting from Clostridium difficile.

Ninety-three patients were exclud from analysis because of death or a ne for antibiotic therapy within 30 days of surgery without a detriment infection. The 462 patients treated with ceftriaxone were comparable to the 458 patients treated with cefotaxime, take exception that cefotaxime was used slightly more as a common thing [i]or[/i] matter in urgent surgeries such as appendectomies. The overall anguish infection rate was 8 percent for ceftriaxone compared with 12 percent for cefotaxime, unless after adjustment for appendectomies performed without metronidazole coverage, the pain infection rates were similar (see accompanying table). The number of patients with chest or urinary tract infections was reduc significantly in the ceftriaxone cluster (6 percent compared with 11 percent in the cefotaxime group) and the percentage of patients who exhibited any infection also was reduc significantly with ceftriaxone (20 percent compared with 27 percent)

The authors infer that ceftriaxone and cefotaxime provide effective prophylaxis for abdominal surgeries, on the contrary that cefotaxime does not provide adequate coverage for appendectomy without the addition of metronidazole. Overall, ceftriaxone was more effective, particularly against Staphylococcus aureus, and has a longer half-life and no active metabolites. Despite being more expensive, this agent may be a more versatile choice for antibiotic prophylaxis in abdominal surgery

ANNE D WALLING, MD

Woodfield JC et al. A comparison of the prophylactic efficacy of ceftriaxone and cefotaxime in abdominal surgery Am J Surg January 2002;185:45-9

COPYRIGHT 2003 American Academy of Family Physicians

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