PROPHYLACTIC ANTIBIOTICS IN ABDOMINAL HYSTERECTOMY

BACKGROUND: The cephalosporins, which have been widely used in gynecol ogic surgery, are considered by many to be the drug of choice for chem oprophylaxis. However, their benefit in total abdominal hysterectomy h as remained controversial. This study was done to evaluate the effecti veness of the commonly used cephalosporins in preventing inflammatory com plications which may occur after elective abdominal hysterectomy. STUDY DESIGN: A MEDLINE and manual review of the literature from the p ast 15 years (1977 to 1991), using the terms ''prophylactic antibiotic s,'' ''abdominal hysterectomy,'' and ''cephalosporins,'' was performed . Seventeen prospective trials using cephalosporin prophylaxis alone f or 24 hours perioperatively were evaluated. A meta-analysis of the 2,7 52 study and control patients abstracted was performed to compare post operative infection and febrile morbidity rates.RESULTS: The cephalosp orin group as well as the various generations and individual drugs wer e found to be useful in preventing postoperative infection (p<0.001). Febrile morbidity, however, was effectively prevented (p<0.001) by fir st but not by some second and third generation drugs. Multivariate ana lysis revealed no advantage for the newer, more expensive second and t hird generation cephalosporins studied. When adjusted for confounding factors, the number of doses, the amount of the dose, and the route of administration had significant impact on the outcome events. CONCLUSI ONS: Chemoprophylaxis with cephalosporins was found to be effective in preventing post-hysterectomy infectious complications. A single dose, preoperative injection of first (cefazolin) or second (cefoxitin) gen eration cephalosporin, when administrated intravenously, has been show n to yield the best, cost-effective clinical results.