A randomized trial of one versus three doses of Augmentin as wound prophylaxis in at-risk abdominal surgery. Issue 804 (October 1992)

• Record Type: Journal Article
• Authors: Bates, T.; Roberts, J. V.; Smith, K.; German, K. A.
• Is Part Of: Postgraduate medical journal. Volume 68:Issue 804(1992)
• Page Start: 811
• Page End: 816
• Publication Date: 1992-10
• Subjects: Medicine -- Periodicals; 610
• DOI: 10.1136/pgmj.68.804.811
• Languages: English
• ISSNs: 0032-5473

Abstract

Abstract : In a randomized prospective trial of prophylactic antibiotics in at-risk abdominal surgery, one dose of intravenous Augmentin (amoxycillin 250 mg and clavulanic acid 125 mg) on induction has been compared with three 8 hourly doses in 900 patients. Wound infection rates which included minor and delayed infections were very similar in those given one dose: 48/449 (10.7%) compared with those given three doses: 49/451 (10.9%) 95% confidence limits - 4.25% + 3.9%. There were more septic and sepsis-related deaths in those patients given one dose (14 deaths) than in those given three doses (7 deaths) P > 0.1 95% CL - 0.4% + 3.0%. However, there were more very elderly patients in the one dose group: 64% of the deaths were aged over 80 and all but one had an emergency operation. There was no difference in the other outcome measures studied which included non-fatal deep sepsis, length of postoperative hospital stay, duration of postoperative fever or the use of antibiotics for postoperative infection. One dose of a suitable intravenous antibiotic gives prophylaxis against wound infection in at-risk abdominal surgery which is at least as effective as multiple doses. However, there may be a risk of overwhelming systemic sepsis in very elderly patients having emergency surgery.