PROPHYLAXIS WITH ORAL CEFADROXIL VERSUS INTRAVENOUS CEFUROXIME IN TROCHANTERIC FRACTURE SURGERY - A CLINICAL MULTICENTER STUDY

A prospective, randomized study was performed in 559 patients to compa re two doses of oral cefadroxil with three doses of intravenous cefuor xime as antibiotic prophylaxis in intra- and subtrochanteric hip fract ure surgery. Antibiotic concentrations in the wound fluid were determi ned at the start and at the end of the operation. The first dose of ce fadroxil was given about 2 h before surgery and cefuroxime about 30 mi n before operation. In 226/242 (93%) patients randomized to oral cefad roxil, the concentration in the wound during surgery was on average 15 mu g/ml, i.e., well above the minimum inhibitory concentration (MIC-9 0) for Staphylococcus aureus. In the cefuroxime group, antibiotic leve ls in the wound exceeded the MIC-90 for S. aureus in 204/210 (97%) of the patients at the start and/or at the end of surgery. All patients w ere followed up for 4 months. One deep and five superficial infections occurred in the cefuroxime group and no deep but one superficial infe ction in the cefadroxil group (P = 0.07). S. aureus was cultured in th ree of the infected cases while cultures were negative in four patient s. Four of the seven infected patients had adequate levels of antibiot ic in the wound during surgery, and in three patients no antibiotic as say was performed. The infected patients did not differ in age, sex, o peration time, bleeding or any other basic variable compared with pati ents who healed without complications. Two doses of cefadroxil seems t o be practical and as effective as intravenously administered cefuroxi me as antibiotic prophylaxis in trochanteric hip fracture surgery.