Intraincisional antibiotics in laparotomy wounds

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Abstract
Concentrations of ampicillin after intraincisional instillation in laparotomy wounds were measured in 10 patients undergoing appendectomy. Ampicillin, 1 g, was instilled under the fascia and 1 g in the subcutaneous space during wound closure. Wound secretion was collected every 2 h during the first 24 postoperative hours by cannulation of a fine perforated drain placed in the subcutaneous space. Ampicillin was determined by a disk diffusion method. During the first 8 h the median concentration of ampicillin in wound secretion exceeded 1000 .mu.g/ml; 14 h and 20 h after wound closure the median concentrations were 73 and 14 .mu.g/ml, respectively. The effect of ampicillin in high cocentrations on resistant strains of Bacteroides fragilis was demonstrated in an in vitro experiment. It is concluded that in colorectal surgery the effect on wound sepsis of intraincisional antibiotics as an addition to systemic antibiotic prophylaxis should be evaluated in a clinical trial.