DOUBLE-BLIND COMPARISON OF CEFAZOLIN AND CEFTIZOXIME FOR PROPHYLAXIS AGAINST INFECTIONS FOLLOWING ELECTIVE BILIARY-TRACT SURGERY

Antibiotics have been shown to reduce the incidence of wound infection s after elective biliary tract procedures, Cefazolin and cefoxitin are among the agents most commonly promoted for this purpose, Cefoxitin h as been substituted with ceftizoxime in many institutions; however, th e role of ceftizoxime as a prophylactic agent in this setting has not been determined, To assess the comparative prophylactic efficacies of cefazolin and ceftizoxime in biliary tract surgery, we conducted a dou ble-blind, randomized prospective clinical trial in a tertiary-care te aching hospital, Adult patients were randomized to one of two treatmen t groups and received a 30-min preoperative dose of study drug and as many as two postoperative doses at 12 and 24 h, depending on hospitali zation status, Cefazolin and ceftizoxime were given as 1,000-mg doses; Patients with infections, those receiving prior antibiotics, or those with p-lactam allergies were excluded, Over the 19-month study tenure , 167 patients were enrolled, Seventeen patients were excluded froth a nalysis because of protocol violations, Of the 150 evaluable patients (72 and 78 receiving cefazolin and ceftizoxime doses, respectively), t here was no significant difference among groups regarding sex, age, we ight, preoperative Apache II score, baseline chemistry, and hematologi cal parameters, Groups were also equivalent regarding the surgeon, typ e of procedure, characteristics (blood loss, drains, organ injury, and complications), and duration of hospital stay (mean, 5.6 versus 4.3 d ays [P = 0.31]), No clinical evidence of infection (7-day hospital sta y and 30-day follow-up) was identified in 93% of cefazolin and 92% of ceftizoxime patients (P = 1.0), Microbiological confirmation was found in only 18% of primary-site infections, In conclusion, cefazolin and ceftizoxime appear to be equivalent for the prevention of infection in biliary tract surgery with the dosage regimens studied.