Prophylactic antibiotics for elective laparoscopic cholecystectomy - Are they necessary?

Hypothesis: Prophylactic antibiotic treatment in elective laparoscopic chol ecystectomy does not lower the already low infection rate associated with t his procedure. Design and Setting: Prospective double-blind randomized trial at a communit y-based training hospital. Patients: Four hundred fifty patients undergoing elective laparoscopic chol ecystectomy were randomized into 1 of 3 treatment arms: (1) preoperative ce fotetan disodium, 1 g intravenously; (2) preoperative cefazolin, 1 g intrav enously; and (3) intravenous placebo. There were no demographic differences between groups in age, smoking history, American Society of Anesthesiologi sts score, infection risk class, time of antibiotic administration prior to surgery, and type of skin preparation. Interventions: Laparoscopic cholecystectomy was attempted in all cases; how ever, 10 patients required conversion to an open cholecystectomy and they w ere included in the statistical analysis. Preoperatively, till patients wer e randomized in a blinded manner and received cefotetan, cefazolin, or plac ebo intravenously. Results: There were 10 postoperative infections. In the cefotetan group, th ere were 3 cases of superficial surgical site infections. In the cefazolin group, there were 2 superficial surgical site infections-1 pneumonia and 1 rhinosinusitis. In the placebo group, there were 2 superficial surgical sit e infections and 1 urinary tract infection. The overall infection rate in t his series was 2.4%. Follow-up was per formed at routine postoperative visi ts and by telephone contact. Data were evaluated using the chi(2) test and analysis of Variance with Duncan post hoc test (P < .05). Conclusion: Based on our data, use of prophylactic antibiotics does not dec rease the rate of wound infections in elective laparoscopic cholecystectomy .