Pre-operation single-dose cefuroxime antimicrobial prophylaxis with and without metronidazole in elective gastrointestinal surgery

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Abstract
Cefuroxime is a new semi-synthetic cephalosporin that has an unusually broad antibacterial spectrum and improved stability to β-lactamase degradation from Gram-negative aerobic bacteria as well as some activity against non-β-lactamase-producing strains of Bacteroides fragilis. One hundred and fifty-six patients undergoing elective gastrointestinal surgery were allocated randomly to one of three groups. Patients in group 1 were given 1.5 g cefuroxime i.v., those in group 2 received 1.5 g cefuroxime i.v. and metronidazole (0.5 g i.v. or by 1 g suppository), and those in group 3 acted as controls. With the exception of the anaesthetists who administered the antimicrobial drugs, none of the investigators was aware to which group any individual patient was allocated. Of 52 patients who received cefuroxime alone, five (9.6%) developed infection, three with purulent inflammation. Three (6.7%) out of 48 patients who were given cefuroxime and metronidazole were infected, none with purulent inflammation. Eighteen (32.2%) of 56 patients in the control group developed post-operative infection including 11 with purulent inflammation. The mean serum level of cefuroxime at 1 h in 11 patients was 58.6 mg/l (range 36.6 to 99.1 mg/1) and at 4 h in eight patients was 13.3 mg/l (range 3.4 to 28.0 mg/1).