CEFTRIAXONE IS MORE EFFECTIVE THAN GENTAMICIN METRONIDAZOLE PROPHYLAXIS IN REDUCING WOUND AND URINARY-TRACT INFECTIONS AFTER BOWEL OPERATIONS - RESULTS OF A CONTROLLED, RANDOMIZED, BLIND CLINICAL-TRIAL

A controlled, randomized trial with blind assessment of end points is described comparing ceftriaxone (1 g) given at induction of anesthesia with gentamicin (2 mg/kg) and metronidazole (500 mg) (GM), three time s, every eight hours starting at induction, in preventing wound, chest , and urinary tract infections following bowel operations. Patients wi th inflammatory bowel disease received prophylaxis for five days. Two hundred sixty patients were randomized, and 196 were studied after exc lusions. Ninety-four were given ceftriaxone, and 102 were given GM. Ch est infection was defined as pyrexia plus clinical or radiologic signs of consolidation or the production of purulent sputum. Wound infectio n was diagnosed on the basis of purulent wound discharge or pyrexia pl us swelling, redness, and pain around the wound, and urinary tract inf ection was diagnosed from microbiologic results. There was a significa nt reduction in wound infection (17 percent to 6 percent; P < 0.05) an d in urinary tract infection (8 percent to 1 percent; P < 0.05) in the ceftriaxone group compared with the GM group. Chest infection occurre d in 16 percent of the ceftriaxone group compared with 25 percent of t he GM group, but this difference was not statistically significant. In fected patients were in the hospital more than four days longer than u ninfected patients, a statistically significant difference (P < 0.01). It is concluded that ceftriaxone is superior to GM in reducing postop erative sepsis and that this effect is likely to be due to the sustain ed bactericidal blood levels achieved by ceftriaxone.