Prospective randomized trial of systemic antibiotics in patients undergoing liver resection

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Abstract
Background: Systemic antibiotics are administered frequently after hepatectomy to prevent infective complications, but their effectiveness is uncertain. Methods: A total of 127 patients with liver tumours were prospectively randomized into two groups after hepatectomy: in group 1 (62 patients) no antibiotics were given until the appearance of infective complications; in group 2 (65 patients) intravenous cephazolin 1 g every 6 h and gentamicin 80 mg every 8 h were given for 7 days. On the day before surgery all patients received bowel preparation by clear liquid diet and oral antibiotics (neomycin 1 g and erythromycin 1 g, given together in three doses). Results: The infective complication rate was 23 per cent in both groups (P = 0·95). The hospital costs were higher in group 2 (P < 0·001). Of the group 1 patients, 51 (82 per cent) did not require antibiotic treatment. No patient in either group died after hepatectomy. Conclusion: Postoperative systemic antibiotics cannot prevent infective complications, and their routine use after hepatectomy is unnecessary and costly. The use of antibiotics should be delayed until infective complications and persistent septic symptoms occur.