Antibiotikaprofylax vid kirurgiska ingrepp - SBU

Table 4.1.10 Gastric surgery.
Author
Year
Reference
Country
Study
design
Population
characteristics
Intervention
Method
Number individuals
Control
Number
individuals
Results
Withdrawal
Drop outs
Study quality
and relevance
Comments
Balbo
1991
(abstract)
[49]
Italy
CT
Multicenter
– 11
departments
Elective gastric surgery –
comparison of 2 ab
I1: Mezlocillin 2 g iv 30 min
before skin incision. 2nd
dose at 3 h (n=64)
I2: Mezlocillin 2 g iv (n=53)
SSI
I1: 5/53 (7.5%)
I2: 4/64 (6.2%)
Not stated
Moderate
Equally effective. Single
dose to be preferred
Feltis
1967
[45]
USA
RCT
Randomised study on prophylactive
and to prevent
SSI. OC among other types
of GI surgery SSI defined
I: Pc G 3 mill units, 500 mg
chloramphenicoll and 1 mg
methicillin iv. Just before,
during and after surgery
(n=189)
C: No ab (n=336) SSI
I: 0/52 pts with OC
C: 8/88 pts with OL
(9.5%)
Not stated
Low
Early study. Interesting
control group. Old
fashioned ab. Poor
description of setup
Fukui
1989
[50]
Japan
RCT
Upper GI surgery (mostly
gastrectomies). Definition
of SSI. Careful control of
operative environment.
Comparison of two ab
regimen.
n=203
I: Cefoxitin 2 g iv during
surgery and then 1 g every
8 h for 4 days (n=101)
C: Ceftizoxime
same dose (n=102)
SSI
I: 24/100 (24%)
C: 9/102 (8.8%)
1 pt in cefoxitin
group – allergy
Moderate
Large material. Well
controlled. Infection
only in pts with malignant
diagnosis (90%
of pts). Too long ab.
Ceftizoxime superior
Lewis
1979
[46]
Canada
RCT
Selective use of ab in
high-risk pts. High-risk
pyloric stenosis, malignancy,
emergency
because of perforation
or bleeding. Defined SSI.
n=107
Follow-up 4 weeks
I: High-risk pts 2 g cephaloridine
iv 2 h before operation
and 2 g 5 h later (n=41)
C: High risk no ab
(n=42)
Low risk no ab
(n=24)
SSI
I: High risk 0%
C: High risk 11/42
(26%)
Low risk no ab 0%
0 Moderate
Cephalosporines
superior to placebo
Lewis
1982
[47]
Canada
RCT
Determine value of 2nd
generation cephalosporines
prophylaxis. Gastroduodoenal
surgery. Blinded.
SSI defined.
Follow-up 5–7 days
I: Cefamandole 2 g 1 h before
operation, 2 g when operator
called to the operation and
2 g 5 h after operation (n=32)
C: Placebo (n=28) SSI
I: 1/32 (3%)
C: 8/28 (28%)
Not stated
Moderate
Confirm the value
of prophylactic ab.
One dose may suffice.
Eli Lilly Co sponsor
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