Perioperative Antibiotic Therapy for Penetrating Injuries of the Abdomen

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Abstract
From 1979 to 1981, 152 patients with penetrating injuries of the intra-abdominal gastrointestinal tract were placed on 1 of 3 different perioperative antibiotic regimens in a prospective randomized fashion. The 3 regimens were cefamandole 2 g every 4 h, cefoxitin 2 g every 6 h and ticarcillin 3 g every 4 h and tobramycin 1.5 mg/kg every 8 h. Antibiotics were administered i.v. before and for 48 h following surgical exploration and repair. The 3 treatment groups were similar with respect to age, average number of organ injuries and distribution of organ injuries. Cefoxitin-treated patients experienced uneventful recoveries more often than cefamandole-treated patients (94% vs. 80.3%, P < 0.05) when the incidence of gram-negative wound infection and intra-abdominal abscess formation was considered, while the number of patients who experienced uneventful recoveries in the ticarcillin-tobramycin group was not statistically different from the other 2 groups of patients. Bacteroides fragilis was isolated from 3 of the 6 abscesses occurring in the cefamandole-treated group, while no anaerobes were isolated from abscesses in patients treated with either of the other 2 regimens. Evidently, the most effective perioperative antibiotic regimen for patients with penetrating gastrointestinal wounds should possess activity against both aerobic and anaerobic flora of the bowel.

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