Colectomy, mucosal proctectomy, and ileal pouch-anal anastomosis. A prospective trial of optimal antibiotic management. Oral is superior to systemic antibiotic prophylaxis in operations upon the colon and rectum. Prospective assessment of the efficacy of single dose versus traditional 3-day antimicrobial prophylaxis in 12-core transrectal prostate biopsy. Prevention of infectious complications after transjugular intrahepatic portosystemic shunt in cirrhotic patients with a single dose of ceftriaxone. [Clinical significance of antibiotic prophylaxis for transrectal prostate biopsy]. Comparison of one dose versus three doses of prophylactic antibiotics, and the influence of blood transfusion, on infectious complications in acute and elective colorectal surgery. Preoperative cell-mediated immunity and duration of antibiotic prophylaxis in relation to postopertive infectious complications. A controlled trial in biliary, gastroduodenal and colorectal surgery. [Prophylactic use of antibiotics in cesarean section]. [Short-term antibiotic therapy of post-cesarean-section endometritis]. Single-dose antibiotic prophylaxis in high-risk patients undergoing cesarean section. Antibiotics in open fractures of the distal phalanx? Should antimicrobial prophylaxis in colorectal surgery include agents effective against both anaerobic and aerobic microorganisms? A double-blind, multicenter study. The Norwegian Study Group for Colorectal Surgery. Timing of antibiotic prophylaxis with cefotaxime for prostatic resection: better in the operative period or at urethral catheter removal? [Antibiotic prophylaxis in non-elective cesarean section with single-dose imipenem versus multiple-dose cefotaxime]. [Short or long schemes of antibiotic prophylaxis for prostate biopsy. A multicentre prospective randomised study]. Short-course versus long-course antibiotic treatment of spontaneous bacterial peritonitis. A randomized controlled study of 100 patients. Risk factors in vascular surgical sepsis.
The ideal prophylactic antibiotic regimen has not been established for patients undergoing colectomy, mucosal proctectomy, and endorectal ileoanal anastomosis, a prolonged operation frequently accompanied by abdominal and pelvic contamination and associated with an infection rate up to 20%. The aim of this study was to evaluate, in a prospective, randomized, double-blind fashion, the efficacy of a short perioperative course compared to an extended postoperative course of intravenous antibiotics (cefoxitin) in patients undergoing colectomy with ileoanal anastomosis. Forty patients with ulcerative colitis or familial polyposis coli received a mechanical and oral antibiotic bowel preparation and a standard three-dose perioperative course of intravenous cefoxitin. Patients then were randomized to receive intravenous cefoxitin, 1 g every 6 hours, or placebo for 5 days. No differences in overall postoperative morbidity were observed and neither group developed intra-abdominal, pelvic, or wound infections. It is concluded that a standard three-dose perioperative course of intravenous antibiotics provides adequate prophylaxis in the prevention of infectious complications in patients undergoing colectomy, mucosal proctectomy, and ileoanal anastomosis. The prophylactic effect of a short preoperative loading dose of oral neomycin and erythromycin upon infectious complications following elective operations upon the colon and rectum was compared with the prophylactic effect of systemic administration of metronidazole and gentamicin preoperatively and postoperatively. In this randomized prospective clinical study, 45 patients received neomycin-erythromycin while 48 received metronidazole-gentamicin; all patients were prepared mechanically using whole gut irrigation with a mannitol solution. Both groups were comparable in sex, age, clinical diagnosis and type of operation performed. In the neomycin-erythromycin group, 41 of 45 patients had an uncomplicated postoperative course versus 35 of 48 patients in the other group (p less than 0.001) and fewer wound infections (p less than 0.05). We conclude that the better results observed with the neomycin-erythromycin combination is probably an addition of two effects--the decrease in colon flora and the adequate serum levels of antibiotics during the operation. To prospectively evaluate the efficacy of single dose antibiotic prophylaxis in 12-core transrectal ultrasonography (TRUS) guided prostate biopsy.
                A total of 400 patients who underwent prostate biopsy with TRUS guidance were included. The patients were prospectively randomized in three groups regarding antibiotic prophylaxis. The first group (139 patients) received a single gram of intramuscular ceftriaxone, while the second group (131 patients) had a 3-day course of oral ciprofloxacin. The third group (130 patients) had single oral 500 mg of ciprofloxacin. All patients had urine cultures prior to biopsy and on the second day after biopsy.
                The study groups were compared in terms of the results of urine cultures and clinical parameters. Overall, only seven patients (1.8% of the cases) had positive urine cultures with no difference between these three groups. Additionally, no significant difference was observed regarding morbidity rates in all groups. Only eight patients (2%) developed major complications requiring hospitalization. There was no increase in the rate of infectious complications when the biopsy core numbers were increased up to 12.
                The current study suggests that a single oral dose of antimicrobial prophylaxis is reasonable in TRUS prostate biopsy even in the case of 12-core sampling. Patients with cirrhosis of the liver are prone to bacterial infections. Therapeutic interventions such as endoscopic sclerotherapy increase the risk of bacterial infections in these patients. Following insertion of a transjugular intrahepatic portosystemic shunt (TIPS), the incidence of severe bacterial infections was recently shown to be 20% after elective procedures. This finding suggests antibiotic prophylaxis with the TIPS procedure. Antibiotic prophylaxis using cefotiam or cefotaxime/ampicillin did not significantly reduce infectious complications. The aim of the present study was therefore to investigate the efficacy of two different doses of a long-acting cephalosporin in prevention of bacterial infection after TIPS.
                Eighty-two patients with cirrhosis (age: 52 +/- 2 years) who underwent elective TIPS were randomized to receive a single i.v. dose of either 1 g or 2 g Ceftriaxone 1 hour before the intervention. Patients with evidence of or suspected infections and patients on antibiotic therapy within 7 days prior to TIPS were excluded. Body temperature was monitored t.i.d. for 1 week and white blood count (WBC) and C-reactive protein (CRP) were determined before TIPS and 1 day and 1 week after TIPS.
                Only 2 of 82 patients (2.6%) showed signs of infection following TIPS insertion: One of 40 patients receiving 1 g Ceftriaxone and 1 of 42 patients receiving 2 g Ceftriaxone prior to TIPS developed temperature > 38.5 degrees C. In the latter patient this was due to pneumonia. This patient received antibiotic treatment with imipenem for 10 days. Temperature in the other patient normalized within 12 hours and he did not require antibiotic treatment. No significant differences in temperature, WBC and CRP between the different doses of Ceftriaxone were observed.
                Prophylactic treatment with Ceftriaxone reduces the reported incidence of bacterial infections after TIPS in patients with cirrhosis of the liver. Prophylaxis with 1 g Ceftriaxone seems as efficacious as 2 g. To evaluate the efficacy and safety of single-dose oral antibiotic prophylaxis in the
                Between prevention of post-procedure infections in patients undergoing transrectal prostate biopsy. September 1998 and March 2001, a total of 192 patients who had an abnormal digital rectal examination and/or prostate specific antigen 4 ng/ml or greater underwent transrectal ultrasound guided systematic 13 cores prostate biopsy. The patients were randomly divided into three groups. Group A (62) received a placebo (Vit C) tablet twice a day for 3 days, group B (64) a single dose of ciprofloxacin (0.5 g) and metronidazole (0.4 g), and group C (66) the same combination twice a day for 3 days. Urine cultures were obtained 48 h after the biopsy and blood cultures when patients who developed fever.
                Noninfective complications included were rectal bleeding, haematuria and pain. Infective complications included urinary tract infection and fever. There was no significant difference among the three groups in noninfective complications but the incidence of infective complications in group A was significantly higher than in groups B and C (P < 0.01). There was no significant difference among group B and C in infective complications (P > 0.05).
                Our study shows single-dose oral antibiotic prophylaxis is effective and safe to prevent infectious complications follow transrectal prostate biopsy. In a randomized prospective controlled trial involving 311 patients undergoing acute or elective colorectal surgery, the efficacy and safety of two different single dose and one triple dose regimen of antibiotic prophylaxis, as well as the influence of blood transfusion on postoperative infectious complications, were studied. Postoperative infectious complications occurred in a total of 59 patients (19.0 per cent). There were no major differences between the three treatment groups. Thirty-four patients (10.9 per cent) developed abdominal wound infection, 17 patients (5.5 per cent) intra-abdominal abscess and 16 patients (5.1 per cent) anastomotic leakage. Of 202 patients (65.0 per cent) requiring blood transfusion during hospitalization 57 (28.2 per cent; 95 per cent confidence limits of 23-36 per cent) developed infectious complications, whereas two non-transfused patients (1.8 per cent; 95 per cent confidence limits of 0.2 to 6 per cent; P less than 0.001) developed infectious complications. It is concluded that one single dose of antibiotic prophylaxis in acute and elective colorectal surgery is as protective as a triple dose regimen. The development of infectious complications despite antibiotic prophylaxis is strongly related to blood transfusion. In a prospective controlled trial, 750 patients undergoing elective biliary, gastric or colorectal surgery were randomized to receive short-term or long-term antibiotic prophylaxis--cefotaxime for biliary or gastric, and gentamicin/metronidazole for colorectal operations. In all patients, delayed cutaneous hypersensitivity was preoperatively assessed by simultaneous application of seven standardized recall antigens. Positive reaction was defined as mean diameter greater than or equal to 2 mm, anergy as no positive reaction to any antigen, and a 'score' as the sum (in mm) of all the mean diameters of positive reactions. There was no significant difference in septic complication or mortality rates following short-term vs. long-term prophylaxis. Anergy was found in 21 patients (2.8%), while 63 (8.4%) scored 2-4 and 666 (88.8%) greater than or equal to 5. The incidence of postoperative infectious complications was 25% in the patients with score less than 5 and 10% in those scoring greater than or equal to 5, and the corresponding mortality was 14.3 and 2.1% (both p less than 0.001). In the group with preoperative scores less than 5, the duration of antibiotic prophylaxis influenced neither postopertive infectious complications nor mortality. The objective of this investigation was to determine the effectiveness of ampicillin administration as a prophylactic regime in patients undergoing cesarean section. A double blind randomized study compared a long course of ampicillin (7 days) to a short course of ampicillin (three doses) to placebo. Thirty one patients were included in the placebo group and sixty patients in the drug groups. Only one patient in the placebo group and one in the drug group developed infectious morbidity. There was no significant difference (p less than 0.001) between the placebo and ampicillin groups. Post-cesarean-section endometritis therapy usually combines an intravenous administered antibiotic followed, once fever has remitted, by an oral or intramuscular course of 7-10 days of the same antibiotic. From November 1993 to May 1994 and trying to reduce the length of the treatment we conducted a randomized, comparative study between the conventional post-C-section endometritis treatment used at the Hospital Central Militar (long course) and a short parenteral treatment with the same antibiotics. Thirty one patients were randomized in the short course group and 32 in the long course group. Only in the long course group there was a patient with persistence of infection after ten days of antibiotic treatment (p > 0.05). The short course regimen brought additional advantages as reduction in treatment days as well as discomfort for the intramuscular administration of antibiotics. This observation suggests that a short course of antibiotics based on the patient's clinical response is a safe and less expensive alternative in the treatment of post-C-section endometritis. A prospective, double-blind, placebo-controlled study was performed to determine the effectiveness of single-dose antibiotic prophylaxis in decreasing infectious complications after primary cesarean section. One hundred women at high risk for postoperative infectious morbidity were randomly assigned to receive either placebo or one 2-g dose of ceftizoxime at cord clamping. The incidence of endometritis in the antibiotic group was 6.0 versus 24.5% in the placebo group (P less than .05). The incidence of febrile morbidity in the group receiving one dose of ceftizoxime was 14.0 versus 32.7% in the placebo group (P less than .05). Single-dose ceftizoxime prophylaxis significantly reduced the incidence of endometritis and febrile morbidity in high-risk patients undergoing cesarean section. A prospective trial was undertaken on 85 adult patients with open fractures of the distal phalanges of less than 6 hours duration, treated by conventional surgery. They either received no antibiotic therapy, or cephradine in short or long courses. The infection rate was 30% in the group without antibiotics and less than 3% in the treated groups. Three different antibiotics regimes were compared, with no difference in the infection rate: therefore the simplest and surest method, a single pre-operative dose and a single post-operative dose, is recommended. It is now well demonstrated that a mixed flora of aerobic and anaerobic microorganisms will be found in wound abscesses and peritonitis after bowel surgery. An impressive reduction in infectious complications caused by anaerobic microorganisms can be achieved with nitroimidazole prophylaxis, but considerable uncertainty about the role of agents active against aerobic microorganisms in such prophylaxis still exists. We have earlier reported that a single dose of tinidazole and doxycycline significantly reduces postoperative infections and is superior to doxycycline alone. The effect of an agent active only against anaerobic microorganisms was tested in a double-blind study of 267 patients who underwent elective colorectal surgery. The patients received either tinidazole (1600 mg) and placebo or tinidazole (1600 mg) and doxycycline (400 mg) as a single preoperative infusion. Patients who received tinidazole and doxycycline had significantly fewer infectious complications, reoperations, additional use of antibiotics, and a shorter hospital stay. Microbiologic studies demonstrated that tinidazole alone gave effective protection against anaerobic organisms but did not protect the patients from aerobic gram-negative infectious complications. A single preoperative dose of antimicrobial agents effective against both anaerobic and aerobic bowel organisms seems to be the preferred prophylaxis for patients undergoing colorectal surgery. There are two critical moments for the development of severe infectious complications following transurethral prostatectomy (TURP): the operative and immediate postoperative periods, and the day that the postoperative drainage catheter is removed. To optimize the timing of antibiotic prophylaxis with cefotaxime, two prospective randomized studies were conducted in patients with preoperatively sterile urine. In Study 1, all patients (n = 50) received cefotaxime 1 g intramuscular (i.m.) 1 hour preoperatively and were then randomized to receive either a second identical dose of cefotaxime 1 hour before catheter removal 24 hours later, or no further antibiotic treatment. In Study 2, patients (n = 89) were randomized to receive either cefotaxime 1 g i.m. 1 hour preoperatively or no preoperative antibiotic, after which all received cefotaxime 1 g i.m. 1 hour before catheter removal. Results were compared using identical evaluation criteria for infection in both studies: incidence of fever (temperature > 38 degrees C), bacteriuria (10(5) organisms/mL) and positive blood cultures, and duration of hospital stay (days). In Study 1, infection was significantly reduced with respect to all parameters in the group receiving two doses of cefotaxime, and total drug treatment costs were halved. In Study 2, the groups did not differ with respect to any parameter. We conclude that a single dose of cefotaxime 1 g i.m. 1 hour preoperatively provides inadequate cover for urethral catheter removal 24 hours later, and that prophylaxis with a single dose of cefotaxime 1 g i.m. 1 hour before catheter removal is just as effective as two doses given 1 hour preoperatively and 1 hour before catheter removal. Prophylactic coverage is essential during the action of removing the catheter and the time immediately following the operation. Long-term antibiotic coverage (24 hours or more) is not necessary. Thus, following TURP in patients with preoperatively sterile urine undergoing continuous bladder irrigation for 24 hours postoperatively, the optimal dose schedule for antibiotic prophylaxis with cefotaxime is a single 1-g dose given i.m. 1 hour before catheter removal. Antibiotic prophylaxis reduces the incidence of febrile morbidity in women undergoing non-elective cesarean section. A randomized comparison of prophylactic single dose Imipenem, a carbapenem antibiotic with the broadest antimicrobial spectrum of activity of any antibiotic, with multiple doses Cefotaxime, a third generation cephalosporin, was undertaken in 48 women who underwent non-elective cesarean section (22 receiving Imipenem, 26 Cefotaxime). The incidence of febrile morbidity in the Imipenem group was 4.54% versus 7.69 in patients receiving multiple doses of Cefotaxime. There were non serious complications in the treated groups. We compared the incidence of the Urinary Tract Infection between a single preoperative dose and a three-day antibiotic prophylaxis regimen for transrectal ultrasound guided biopsy in randomized multicenter trial.
                Between February 2006 and December 2007, 322 men who underwent transrectal ultrasound-guided prostate biopsy were included in a multicentre prospective randomised study. Patients received antibiotic prophylaxis by ciprofloxacin orally, either 1g single dose two hours before the biopsy (Group 1: n=139) or a prolonged prophylaxis for three days (Group 2: n=149). Assessment five days before and five days following the biopsy included a clinical examination, biological tests and a self-questionnaire.
                Two patients developed prostatitis, one in each group: 0.75% of the first group, 0.69% of the second. Twelve developed asymptomatic bacteriuria, six in each group: 4.51% of the first group and 4.19% of the second. There was no significant difference between the two groups (Fisher test; p>0.9).
                There was no significant difference between the two antibiotic prophylaxis regimen (one single dose or three days) for patients undergoing TRUS guided biopsies. Therefore, the single preoperative dose should be the preferred option. In an attempt to determine the optimal duration of therapy of spontaneous bacterial peritonitis, 100 patients with neutrocytic ascites and suspected spontaneous bacterial peritonitis were randomized to short-course vs. long-course treatment groups. Empiric therapy was initiated before the results of ascitic fluid culture were available. Of the 90 patients who met strict criteria for spontaneous bacterial peritonitis or culture-negative neutrocytic ascites, 43 were randomized to a group receiving 5 days and 47 to a group receiving 10 days of single-agent cefotaxime, 2 g IV every 8 hours. Infection-related mortality (0% vs. 4.3%), hospitalization mortality (32.6% vs. 42.5%), bacteriologic cure (93.1% vs. 91.2%), and recurrence of ascitic fluid infection (11.6% vs. 12.8%) were not significantly different between the 5- and 10-day treatment groups, respectively. Recurrence rates were comparable to the values reported in the literature. The cost of antibiotic and antibiotic administration were significantly lower in the short-course group. Short-course treatment of spontaneous bacterial peritonitis is as efficacious as long-course therapy and significantly less expensive. The risk factors for sepsis after vascular surgery were studied in 100 consecutive patients with lower limb arterial ischaemia. Patients were randomised either to a short or long course of antibiotic prophylaxis with amoxycillin/clavulanic acid combination (Augmentin). Pathogenic organisms were isolated from the skin preoperatively in 39 (36%) cases, significantly more frequently in patients with ischaemic rest pain and skin necrosis (66%) than rest pain alone (21%) (P = 0.0004) or claudication/aneurysm (11%) (P = 0.0001). All but three organisms isolated (5%) were sensitive to amoxycillin/clavulanic acid. A wound infection occurred after 21 (19%) reconstructions, significantly more frequently both in patients suffering rest pain with skin necrosis (P = 0.001) and rest pain without skin necrosis (P = 0.04) compared with claudication/aneurysm. Sixteen of the 21 patients with a wound infection had at least one organism isolated from their skin preoperatively (P = 0.0001). Twelve patients (57%) had a similar organism isolated from the skin preoperatively and from the postoperative wound infection. Reducing the course of antibiotic prophylaxis from 5 days to 3 doses did not significantly increase the infection rate. The only other significant risk factor for sepsis was increasing age of the patient. Although prophylaxis is undisputed in patients having synthetic grafts, antibiotics may not be as important in the prevention of wound sepsis as had been thought. The role of antiseptic agents requires further evaluation.
Antibiotic prophylaxis is effective in preventing infectious complications following TRPB. There is no definitive data to confirm that antibiotics for long-course (3 days) are superior to short-course treatments (1 day), or that multiple-dose treatment is superior to single-dose.