Antibiotic prophylaxis in oesophageal surgery

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Abstract
A prospective randomised study to assess the efficacy of antibioticprophylaxis in oesophageal surgery was performed, in which 226 consecutivepatients (113 male and 113 female, age range 24-86 years, mean age of 65years) were included. The study patients were in two groups: group 1, inwhich the upper alimentary tract was opened during surgery, and group 2, inwhich it was not. The group 1 patients (n = 129) were randomised to one ofthree antibiotic prophylaxis regimes prior to surgery. Group A patients (n= 42) were treated with cefuroxime (CFX) 1.5 g at induction of anaesthesiaand then CFX 750 mg b.i.d. for 4 days. Group B patients (n = 46) weretreated with CFX 1.5 g and metronidazole (MTR) 1.0 g at induction ofanaesthesia, then CFX 750 mg b.i.d. and MTR 500 mg qds for 4 days. Group C(n = 41) treated with CFX 1.5 g and MTR 1.0 g at the induction ofanaesthesia. Group 2 (n = 97) was divided into two groups, group D (n = 47)treated with CFX 1.5 g on induction of anaesthesia alone. Group E (n = 50)treated with CFX 1.5 g on induction of anaesthesia then CFX 750 mg bd for 2days. We found a significantly higher incidence of infective complicationsin subgroup C (43.9%) and subgroup A (21.4%) compared to subgroup B (8.6%).This difference was most marked in patients undergoing oesophagectomy. Wefound significantly higher infection rates of infective complications insubgroup D (10.6%) as compared to subgroup E (2%).

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