title: Multicenter trial of prophylaxis with clindamycin plus aztreonam or cefotaxime in gynecologic surgery. Laparoscopically assisted vaginal hysterectomy versus abdominal hysterectomy in stage I endometrial cancer A randomized, double-blind, placebo-controlled comparison of the effect of nitrofurantoin monohydrate macrocrystals on the development of urinary tract infections after surgery for pelvic organ prolapse and/or stress urinary incontinence with suprapubic catheterization. A randomized controlled trial comparing ceftriaxone with cefazolin for antibiotic prophylaxis in abdominal hysterectomy. Single-dose Piperacillin Versus Triple-dose Cefoxitin Prophylaxis at Vaginal and Abdominal Hysterectomy Vaginal hysterectomy: cefuroxime, metronidazole or both? Prophylaxis in gynaecological and obstetric surgery: a comparative randomised multicentre study of single-dose cefotetan versus two doses of cefazolin. Antimicrobial Prophylaxis in Laparoscopic Gynecologic Surgery: A Prospective Randomized Study Comparing Amoxicillin-Clavulanic Acid with Cefazolin Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States. The Collaborative Review of Sterilization. Ampicillin combined with sulbactam or metronidazole for single-dose chemoprophylaxis in major gynaecological surgery. Short course of prophylactic antibiotics in laparoscopically assisted vaginal hysterectomy. Prevalence, pattern, sensitivity and resistance to antibiotics of different bacteria isolated from port site infection in low risk patients after elective laparoscopic cholecystectomy for symptomatic cholelithiasis at tertiary care hospital of Kashmir. Oral trovafloxacin compared with intravenous cefoxitin in the prevention of bacterial infection after elective vaginal or abdominal hysterectomy for nonmalignant disease. Trovafloxacin Surgical Group. Metronidazole prophylaxis to prevent infections after total abdominal hysterectomy Cefazolin is inferior to cefotetan as single-dose prophylaxis for women undergoing elective total abdominal hysterectomy. Prospective randomized study comparing amoxicillin‐clavulanic acid with cefazolin as antimicrobial prophylaxis in laparotomic gynecologic surgery Guidelines for antibiotic prophylaxis in gynecology. Amoxycillin/clavulanate prophylaxis in gynecologic surgery. Single-dose prophylaxis in hysterectomies Randomized double-blind comparison of mezlocillin versus cefoxitin prophylaxis for vaginal hysterectomy. Placebo-controlled, double-blind, randomized study of prophylactic antibiotics in elective abdominal hysterectomy. Preventing major operative site infection after radical abdominal hysterectomy and pelvic lymphadenectomy. A prospective randomized double-blind trial of ceftriaxone versus no treatment for abdominal hysterectomy. Comparison of the Antimicrobial Prophylactic Efficacy of Cefotaxime and Cephazolin in Obstetric and Gynaecological Surgery Comparative Efficacy of Short-Term Versus Long-Term Cefoxitin Prophylaxis Against Postoperative Infection After Radical Hysterectomy: A Prospective Study
abstract: A prospect i ve , r and omized , multicenter study was conducted on the efficacy and safety of two prophylactic antibiotic regimens in both abdominal and vaginal hysterectomy . Patients received three intravenous doses of clindamycin ( 900 mg ) plus either aztreonam ( 1 g ) or cefotaxime ( 1 g ) ; the doses were given at the induction of anesthesia and 8 and 16 hours later . A total of 170 patients undergoing abdominal hysterectomy and 142 patients undergoing vaginal hysterectomy completed the trial and were evaluated . Following abdominal hysterectomy infections occurred at the operative site in 1.2 % of patients given a regimen including aztreonam and in 4.7 % of those given a regimen including cefotaxime ; the difference between the two groups was not significant . Neither were significant differences observed in the incidence of fever , the incidence of bacteriuria , the need for postoperative antibiotics , or the duration of postoperative hospitalization , although results were slightly better for patients receiving clindamycin plus aztreonam . Following vaginal hysterectomy , slightly but not significantly better results for the same parameters were obtained in the group given clindamycin plus cefotaxime .  Diarrhea was the only adverse reaction attributable to antibiotic treatment and occurred more frequently in patients given cefotaxime . It was concluded that the two regimens were similarly effective and safe in preventing infections following hysterectomy Abstract .Fram KM . Laparoscopically assisted vaginal hysterectomy versus abdominal hysterectomy in stage I endometrial cancer . The purpose of this study was to evaluate and compare laparoscopic treatment for stage I endometrial cancer with the traditional transabdominal approach . From July 1996 to July 1998 , 61 patients with clinical stage I endometrial cancer were treated at the Gynaecology Oncology Unit at the Royal North Shore of Sydney , Australia . Twenty-nine patients were treated with laparoscopic assisted vaginal hysterectomy ( LAVH ) and bilateral salpingo-oophrectomy ( BSO ) ± laparoscopic pelvic lymphadenectomy ( LPLA ) , while 32 patients were treated with the traditional laparotomy and underwent total abdominal hysterectomy ( TAH ) and BSO ± pelvic lymphadenectomy ( PLA ) . The main outcomes studied were operative time , blood loss , blood transfusion , intraoperative complications , postoperative complications , duration of hospital stay , and number of lymph nodes obtained . In conclusion , laparoscopic treatment of endometrial cancer is safe in the h and s of experienced operators with minimal intraoperative and postoperative complications . This procedure is associated with significantly less blood loss and shorter hospitalization ; however , it is associated with significantly longer operating time . Proper selection of patients for the laparoscopic procedure is the vital step in achieving the major goals of this approach OBJECTIVE The purpose of this study was to determine if antibiotic prophylaxis with nitrofurantoin monohydrate macrocrystals ( study drug ) after pelvic organ prolapse and /or urinary incontinence surgery with suprapubic catheterization ( SPC ) decreases urinary tract infection ( uti ) compared with placebo in a r and omized , double-blind , multicenter trial . STUDY DESIGN Six centers participated in this study . After a negative preoperative urine culture , history , surgical and postoperative course , urine culture and symptoms at SPC removal , and at 6 to 8 weeks postoperative , any other UTI and adherence were recorded . To demonstrate a 50 % decrease in the bacteruria rate from 20 % , with 80 % power and alpha of 0.05 , 438 patients were required . Data were evaluated with Student t test and Fisher exact test . RESULTS Of 449 patients enrolled , 211 r and omized to study drug , and 224 r and omized to placebo . No pre- or perioperative differences existed between groups ( all P>.05 ) . Antibiotic prophylaxis decreased positive urine cultures compared with placebo ( 46 % vs 61 % , P=.002 ) , symptomatic UTI at SPC removal ( 7.2 % vs 19.8 % , P=.001 ) , and any other symptomatic UTI 6 to 8 weeks postoperatively ( 18.9 % vs 32.6 % , P=.002 ) . Antibiotic prophylaxis did not decrease symptomatic UTI at the 6- to 8-week postoperative visit ( 1.8 % vs 5.4 % , P=.10 ) . CONCLUSION Antibiotic prophylaxis with nitrofurantoin monohydrate macrocrystals decreases UTI compared with placebo after pelvic organ prolapse and /or urinary incontinence surgery with suprapubic catheterization OBJECTIVE To compare the effectiveness of ceftriaxone versus cefazolin for the prevention of febrile morbidity and postoperative infections among patients after abdominal hysterectomy . METHODS In a double-blind , r and omized , controlled trial in Bangkok , Thail and , 320 patients undergoing abdominal hysterectomy between July 2008 and July 2009 were r and omly assigned to receive 1 g of either ceftriaxone or cefazolin intravenously in a single dose before surgery . The participants were evaluated for postoperative fever and infection for up to 4 weeks . χ(2 ) or Fisher exact tests were used for statistical analysis . RESULTS There was no significant difference between the ceftriaxone and cefazolin groups in incidence of febrile morbidity ( 9.4 % versus 11.2 % ) , wound infection ( 3.8 % versus 1.9 % ) , vaginal cuff infection ( 3.8 % versus 1.9 % ) , or urinary tract infection ( 1.9 % versus 1.9 % ) . CONCLUSION There was no difference between the use of single-dose preoperative ceftriaxone and cefazolin in preventing infectious morbidity among patients undergoing hysterectomy Two hundred fourteen women having vaginal or abdominal hysterectomy were entered into a prospect i ve , r and omized , blind clinical trial comparing a preoperative intravenous dose of piperacillin to three perioperative intravenous doses of cefoxitin given over an eight-hour period . Interregimen clinical , surgical , and outcome variables of the 207 evaluable subjects were statistically similar , but there were significant interprocedure differences in a variety of categories ; many benefits exist when vaginal hysterectomy is possible . Efficacy of a single dose of piperacillin was similar to that of three cefoxitin doses . Seven women ( 3.4 % ) had major postoperative infection requiring parenteral antimicrobial  therapy , two ( 1.9 % ) after vaginal hysterectomy and five ( 4.8 % ) after abdominal hysterectomy . Three of the latter five infections ( 60 % ) occurred after discharge from the hospital . Even with prophylaxis , postoperative anemia was associated with increased frequency of infection at the operative site after both procedures , and diabetes was associated with late infection of the abdominal incision after abdominal hysterectomy A r and omized double-blind prospect i ve study on the efficacy of single-dose antibiotic prophylaxis compared cefuroxime versus metronidazole versus the combination of both agents in vaginal hysterectomy . Overall antibiotic prophylaxis was effective in abscess prevention ( one abscess in 68 patients ) . In the metronidazole group a significantly higher grade of morbidity was observed : febrile morbidity 41 % versus 4 % in the two other groups ; bacteriuria 73 % versus 17 % in the cefuroxime group , versus 13 % in the combined group ; urinary tract infection 23 % , versus 0 % in the two other groups ; post-operative prescription of antibiotics 41 % , versus 0 % in the two other groups . Febrile morbidity and bacteriuria correlated positively withEscherichia coli and Proteus spp . These micro-organisms were recovered significantly more often from the vagina of patients in the metronidazole group . Cefuroxime was successful , metronidazole failed in the prevention of minor morbidity . We could not observe any effect from the addition of metronidazole to the cefuroxime prophylaxis Antimicrobial prophylaxis is recommended in all clean-contaminated surgery where the critical threshold of number and virulence of the contaminating organisms with respect to host resistance is reached . Obstetric and gynaecological surgery is clean-contaminated and risk of infection due to aerobic and anaerobic bacteria without prophylaxis can be quantified at 30 - 40 % for vaginal hysterectomy , 10 - 35 % for abdominal hysterectomy and 10 - 34 % for caesarean section . To assess the role of two different cephalosporins as short term prophylaxis , we carried out a multicentre r and omised study involving a single 2 g i.v . dose of cefotetan in comparison with two doses of cefazolin ( 2 g i.v . before surgery and after 8 hours ) . Criteria for exclusion were : exposure to antibiotics within 7 days , preoperative infection , hypersensitivity to beta-lactams . Four hundred and sixty patients entered the study , of which 229 received  cefotetan and 231 cefazolin . No significant differences in mean age , obesity , preoperative weight loss , diabetes , type of disease , type of surgery ( vaginal or abdominal hysterectomies and caesarean sections ) and number of pregnancies and abortions existed between the two groups of patients . The total rate of infected patients undergoing hysterectomy  was 8.6 % ( 13/151 ) in the cefotetan group and 17.4 % ( 29/167 ) in the cefazolin group ( p less than 0.05 ) . This difference was due to cases of symptomatic bacteriuria and antibiotic retreatment , while wound infections were not significantly different ( 2.6 % and 1.8 % respectively ) . Among patients undergoing caesarean section , 9 of 78 ( 11.5 % ) and 7 of 64 ( 10.9 % ) were infected following cefotetan and cefazolin , respectively ( not significant ) . Cefotetan mean tissue concentrations in gynaecological organs were higher than those of cefazolin ( 25.5 - 44.8 vs. 7.4 - 9.5 mg/kg ) . ( ABSTRACT TRUNCATED AT 250 WORDS Abstract Numerous studies have been published in recent years about antimicrobial prophylaxis in gynecologic surgery , but the optimal drug and schedule for the different surgical procedures is still a matter of debate . The aim of the present study was to compare two ultra-short term antimicrobial prophylaxis regimens ( amoxicillin-clavulanic acid and cefazolin ) in preventing infections following laparoscopic gynecologic operations . Three hundred sixty women hospitalized for a laparoscopic gynecologic surgery procedure were included in the study between January 1999 , and December 2001 . Patients were r and omly allocated to receive amoxicillin-clavulanic acid ( 2.2 g ) [ Group A ] or cefazolin ( 2 g ) [ Group B ] as a single dose 30 minutes before surgery . Each patient was assessed daily until discharge to evidence febrile status and the presence of infections at the operative site , urinary tract and respiratory tract . In the amoxicillin-clavulanic acid ( Group A ) and cefazolin ( Group B ) groups , overall 164 and 172 patients , respectively , were evaluable for prophylactic efficacy at hospital discharge . Infectious complications were infrequent in both groups with febrile morbidity occurring in only one patient ( 0.6 % ) in the amoxicillin- clavulanic group . No sign of infections at the surgical site , urinary tract and respiratory tract was observed in either group . No death due to sepsis was recorded . It is concluded that ultra-short term prophylaxis with both amoxicillin-clavulanic acid and cefazolin is safe and effective in elective laparoscopic gynecologic surgery Although hysterectomy was the most frequently performed major surgical procedure among women of reproductive age during the past decade , few recent studies have been conducted to determine the risk of complications . We examined data from the Collaborative Review of Sterilization , a prospect i ve , multicenter , observational study coordinated by the Centers for Disease Control , to assess the comparative risks of complications among women undergoing hysterectomy by the abdominal and vaginal approaches . Between September , 1978 , and August , 1981 , 1,851 women from nine institutions were included in the study . Women who underwent vaginal hysterectomy  experienced significantly fewer complications than women who had undergone  abdominal hysterectomy . The difference was probably attributable to the prevalence and efficacy of prophylactic antibiotic use among the former group . Vaginal hysterectomy was associated with more unintended major surgical procedures but less febrile morbidity , bleeding requiring transfusion , hospitalization , and convalescence than abdominal hysterectomy . Vaginal hysterectomy with prophylactic antibiotics should be strongly considered for those women of reproductive age for whom either surgical approach is clinical ly appropriate A double-blind , placebo-controlled and r and omized trial involving a total of 295 patients was carried out to define the role of chemoprophylaxis in major gynaecological surgery in our hospital . Perioperative administration of a single dose of ampicillin ( 500 mg ) plus sulbactam ( 500 mg ) ( regimen A ) , or ampicillin ( 500 mg ) plus metronidazole ( 1 g suppository ) ( regimen B ) , gave similar results . After abdominal hysterectomy , the rates of post-operative wound infection and febrile morbidity were significantly reduced from 24 % ( 12/49 ) and 20 % ( 10/49 ) in the placebo group to 3 - 4 % ( A = 2/51 , B = 3/58 ) and 2 % ( A = 1/51 , B = 1/58 ) respectively . After vaginal hysterectomy , pelvic/vaginal infection or febrile morbidity was found in 30 % ( 3/10 ) of patients in the placebo group but none in either treatment group ( A = 10 , B = 8) . After other types of operation , the rates of infectious complications were reduced , but not statistically significantly , from 11 % ( 4/38 ) to 4 % ( A + B 2/71 ) . However , the rates of post-operative urinary tract infection remained similar in the placebo and treatment groups ( 12 - 16 % ) OBJECTIVE To evaluate whether a short course of prophylactic antibiotics is as efficacious as a longer course in laparoscopically assisted vaginal hysterectomy ( LAVH ) . STUDY DESIGN A total of 156 patients who underwent LAVH were included in the study ; 82 received a long course of combined prophylactic antibiotics  , and 74 received a short course , administered for < 24 hours during the perioperative period . The subjects were r and omly assigned using a computer-generated schedule . Data regarding re source consumption were collected from the hospital 's electronic data base . Patient characteristics and medical care process data were collected from the patient charts . Student 's t test was used to determine the statistical significance of the differences between continuous variables in the 2 groups of patients . The chi2 test was used to measure the statistical significance of differences between nominal variables in the 2 groups . RESULTS The short course significantly influenced the number of injected vials of antibiotics , the antibiotic fee and the total admission fee . The average total admission fee decreased by 2.3 % ( p = 0.034 ) , and the average antibiotic-fee dropped by 68.4 % ( p < 0.01 ) . The average injected vials of cephalothin  decreased by 4.3 , and the vials of gentamycin decreased by 3.3 ( p < 0.01 ) . As for the rate of operative site infection and urinary tract infection during hospitalization and within 7 days of discharge , no statistical differences were found between the 2 groups ( p = 0.735 ; p = 0.917 ) . CONCLUSION This pilot study revealed that a short course of prophylactic antibiotics was as efficacious as a longer course in preventing postoperative infection . It was also cost-effective The aim of this study was to determine specific pattern of port site microbial colonisation , sensitivity and resistance to different antibiotics of bacteria isolated from port site infection ( PSI ) in low risk patients after elective laparoscopic cholecystectomy in surgical wards at tertiary care hospital of Kashmir . This is a prospect i ve study . The study included 675 consecutive patients of postoperative PSI after elective laparoscopic cholecystectomy for symptomatic cholelithiasis over a period of 12 months . Culture swabs were taken from port sites with signs of PSI and transported to the microbiology laboratory . The positive swab cultures were subjected to antibiotic susceptibility test . The data obtained was analysed by using appropriate statistical analytical tests . The incidence of PSI after elective laparoscopic cholecystectomy is 6·7 % . The commonest organism responsible for PSI is pseudomonas , 19 ( 42·2 % ) cases . Most of the strains of organisms isolated were resistant to commonly used antibiotics in the hospital , pseudomonas was found 100 % resistant to the combination of ampicillin + sulbactum and ceftriaxone and it was sensitive to imipenem , amikacin and vancomycin in 89·47,57 and 52·63 % of cases respectively . Our study will be helpful in choosing effective empirical prophylactic antibiotic therapy in cases of elective laparoscopic cholecystectomy and will have a great impact on morbidity and mortality in them because of PSI BACKGROUND Trovafloxacin is a new fourth-generation fluoroquinolone whose pharmacokinetics and in vitro activity suggest that it is well suited for antibiotic prophylaxis in elective hysterectomy . METHODS In a r and omized , double-blind , multicenter study , parallel groups of women 18 years of age or older received either 200 mg trovafloxacin by mouth and intravenous ( i.v . ) placebo or 2 g cefoxitin by i.v . infusion and placebo by mouth before elective vaginal or abdominal hysterectomy for nonmalignant disease . RESULTS In the 103 and 97 patients in the trovafloxacin and cefoxitin groups , respectively , who were evaluable for efficacy , the prophylactic success rates at hospital discharge ( 96 % in both groups ) and 30 + /- 6 days after hysterectomy ( 88 % and 91 % in the trovafloxacin and cefoxitin groups , respectively ) were statistically equivalent . Both antibiotics were well tolerated . CONCLUSION A single oral 200 mg dose of trovafloxacin is as effective and safe as a st and ard cefoxitin parenteral regimen in the prevention of primary bacterial infection after elective vaginal or abdominal hysterectomy for nonmalignant disease METHODS In a r and omized double-blind study , 134 patients were given 500 mg metronidazole as an intravenous infusion immediately before operation for abdominal total hysterectomy and again 8 hours later and 124 patients received placebo . RESULTS There was more wound infection , postoperative hospitalization was longer and the sedimentation rate on the sixth postoperative day was significantly higher in the placebo group . There was no difference in postoperative temperature . Postoperative wound infections occurred in 12 % in the placebo group and 6 % in the metronidazole group . Eight percent in the total material had urinary tract infections , the diagnosis was based on urine cultures . CONCLUSIONS Prophylaxis with intravenous infusion of metronidazole is recommended in total hysterectomies The purpose of this prospect i ve , r and omized , double-blind clinical trial was to compare the efficacy of 1-g doses of intravenous cefazolin with that of 1-g doses of intravenous cefotetan in preventing major operative site infections after elective abdominal hysterectomy . A major operative site infection requiring parenteral antimicrobial therapy developed in 46 ( 9 % ) of 511 evaluable women : 30 ( 11.6 % ) of 258 women given cefazolin prophylaxis and 16 ( 6.3 % ) of 253 women given cefotetan prophylaxis ( relative risk , 1.84 ; 95 % confidence interval , 1.03 to 3.29 ; P < .05 ) . Risk factors for major operative site infection were younger age , lower postoperative hemoglobin concentration , and a proliferative endometrium . Ten ( 3.9 % ) of 258 women given cefazolin prophylaxis had a postoperative pelvic abscess ; two of these women required additional surgical procedures , compared with two ( 0.8 % ) of 253 women given cefotetan prophylaxis who had an abscess but did not require surgery ( relative risk , 4.9 ; 95 % confidence interval , 1.09 to 22.16 ; P = .04 ) . A greater number of infections and more serious infections occurred following cefazolin prophylaxis ; this treatment result ed in 234 additional hospital days for administration of parenteral antimicrobial therapy Background . To compare amoxicillin‐clavulanic acid with cefazolin as ultra‐short‐term prophylaxis in laparotomic gynecologic surgery Using a r and om table of numbers , 100 premenopausal women undergoing vaginal hysterectomy were assigned to a short-term or long-term antibiotic prophylaxis regimen . The short-term regimen patients received a total of 3 Gm . of cephaloridine in divided doses on the day of operation , while the long-term regimen patients also received oral cephalexin postoperatively . The preoperative profiles of the two study groups were similar , and the postoperative results were not significantly different . A quantitative evaluation of aerobic and anaerobic bacteria recovered from the surface of the vagina was done , and  cephaloridine content of vaginal washings , serum , and vaginal tissue was determined . This information was utilized to suggest guidelines for antibiotic prophylaxis in gynecology used as antibiotic prophylaxis in abdominal and gynecologic surgery being effective against most bacteria , including anaerobes w1,2x . Different reported protocol s of antibiotic prophylaxis tend to reduce doses and it is now usual to give a single administration before the start of the surgery w3x . To evaluate this concept , we compared the efficacy of a single preoperative dose of amoxycillinyclavulanate ( AyC ) with a two-dose administration , one 30 min before the operation and the other 8 h later . The study included 358 women admitted to our Department for surgery . Exclusion criteria were : allergy to the study drug , serious renal and yor hepatic diseases , antibiotic or corticosteroid treatment in the 14 days before surgery . Subjects were assigned r and omly to one of the two treatment groups : 190 patients received 2.2 g of AyC i.v . before surgery ( group 1 ) , while 168 patients received a second dose after 8 h ( group 2 ) . St and ard preoperative and postoperative assessment was carried out in all patients . All operations were performed by the same gynecologists . The subjects were divided according to : type of surgery The efficacy of single-dose prophylaxis with intravenous cefuroxime 1,500 mg plus 500 mg metronidazole in vaginal or abdominal hysterectomies was investigated in a r and omized , double-blind , placebo-controlled study , involving 396 evaluable patients . A significant reduction of the number in urinary tract infections was observed in the groups undergoing abdominal hysterectomy or vaginal hysterectomy with vaginal repair . The incidence of wound infections and the duration of hospitalization were significantly reduced in patients undergoing vaginal hysterectomy with or without vaginal repair .  Body temperature normalized faster in all three groups receiving peri-operative antibiotic prophylaxis . It is concluded that a single injection of antimicrobial prophylaxis is sufficient and useful in both abdominal and vaginal hysterectomies One hundred patients undergoing vaginal hysterectomy were enrolled in a r and omized double-blind comparative antibiotic prophylaxis study . Forty-six patients received mezlocillin and 54 patients received cefoxitin . No significant difference was found among patients who developed febrile morbidity . Failure rate for mezlocillin was 17 per cent and for cefoxitin , 15 per cent . There was an increase in colonization of Streptococcus faecalis and Enterobacter species in patients receiving three doses of cefoxitin prophylaxis To assess the efficacy of a single dose of ampicillin or cefazolin in preventing fever and infection after elective abdominal hysterectomy , we conducted a multicentre , r and omized , double-blind , controlled trial at Srinagarind Hospital , Faculty of Medicine , Khon Kaen University and Khon Kaen Regional Hospital . Three hundred and thirty patients scheduled for elective abdominal hysterectomy were r and omly allocated into either placebo , ampicillin or cefazolin groups . Patients received sterile water ( 3 mL ) or ampicillin ( 1 g ) or cefazolin ( 1 g ) intravenously according to r and om assignment 30 min before the operation . After the operation , all patients were assessed by blinded independent evaluators until discharged from the hospitals . Our main outcome measures were postoperative fever and infectious morbidity . We found that 321 patients ( 97.3 % of recruited patients ) were available for data analysis , 108 in placebo , 106 in ampicillin and 107 in cefazolin group . Febrile morbidity occurred in 13/108 ( 12.0 % ) , 14/106 ( 13.2 % ) and 12/107 ( 11.2 % ) of patients in the placebo , ampicillin and cefazolin groups , respectively . There was no statistically significant difference in febrile morbidity between the three groups . Infectious morbidity was found in 29/108 ( 26.9 % ) , 24/106 ( 22.6 % ) and 11/107 ( 10.3 % ) of patients in the placebo , ampicillin and cefazolin groups , respectively . There was a statistically significant difference between the placebo and cefazolin groups ( P = 0.002 ) . Between the placebo and ampicillin groups , the result was not significantly different ( P = 0.476 ) . There was a statistically significant difference between the cefazolin and ampicillin groups ( P = 0.015 ) . The common causes of infectious morbidity were urinary tract infection , vaginal cuff infection and surgical wound infection . We concluded that antibiotic prophylaxis by cefazolin should be recommended for elective total abdominal hysterectomy Twenty-one women who underwent radical abdominal hysterectomy and pelvic lymphadenectomy were enrolled in a prospect i ve , comparative , r and omized , placebo-controlled clinical trial of antimicrobial prophylaxis . Preoperative endocervical flora was identified and was similar in pre- and postmenopausal private and clinic service women ; 46 % of the 119 preoperative isolates produced beta-lactamase enzyme . Women were given three doses of either placebo or cefoperazone plus sulbactam , an irreversible beta-lactamase enzyme inhibitor . Three women ( 27 % ) given placebo developed abdominal incision infections ; one women given placebo also developed a pelvic infection . None given antibiotic developed operative site infection , but one women developed a drain site infection . A major operative site infection rate of 27 % observed with placebo is high enough to warrant prophylaxis . Although antimicrobial prophylaxis at radical hysterectomy and pelvic lymphadenectomy eradicted operative site infection in our patient population s , a literature review indicates that individual determination of a requirement for prophylaxis is necessary The value of preoperative prophylactic parenteral treatment with ceftriaxone at elective abdominal hysterectomy was investigated in a prospect i ve , r and omized , double-blind study , in which 157 women participated , 77 in the antibiotic group and 80 in the control group . Increased febrile morbidity and a significant preponderance of women with urinary tract infections were observed in the untreated group , whereas there was no significant difference between the two groups regarding wound infections or infiltration at the top of the vagina . We find no indication for routine prophylactic use of antibiotics at elective abdominal hysterectomy Summary A prospect i ve r and omised multicentre study was design ed to assess the efficacy of 2 different cephalosporins as short term prophylactic treatment in obstetric and gynaecological surgery . A single dose of cefotaxime ( 2 g IV before surgery ) was compared with 2 doses of cephazolin ( 2 g IV before surgery and after 8 hours ) . Patients exposed to antibacterial drugs within 7 days , who had preoperative infections , or with known β-lactam hypersensitivity were excluded . 612 patients entered the study , of whom 552 were evaluable . 276 were given cephazolin ( group A ) and 276 cefotaxime ( group B ) . Groups A and B were similar for mean age , obesity , diabetes , types of diseases and obstetric history . No significant differences were observed in type of surgery ( vaginal hysterectomy , abdominal hysterectomy , myomectomy and caesarean section ) between the 2 groups . The mean duration of surgery was 89 and 85 minutes in group A and B , respectively . 25 patients ( 9.1 % ) in group A and 20 ( 7.2 % ) in group B developed wound infections ( not statistically significantly different ) . The percentages of patients with infections other than surgical infections were similar ( i.e. 13.0 and 11.2 for the cefotaxime and the cephazolin groups , respectively ) . These preliminary data show that a single 2 g IV dose of cefotaxime and two 2 g IV doses of cephazolin have equal antimicrobial prophylactic activity in obstetric and gynaecological surgery We report the results of a r and omized , double-blind comparison of short-term versus long-term cefoxitin prophylaxis against infections after radical abdominal hysterectomy with pelvic and para-aortic lymphadenectomy . Of 113 evaluable patients , 54 ( 47.8 % ) received short-term ( three doses ) and 59 ( 52.2 % ) long-term ( 12 doses ) prophylaxis with intravenous cefoxitin ( 2 g per dose ) . No significant differences demographics , preoperative risk factors , or clinical course were detected between the two groups ; nor did we detect significant differences in the incidence of surgical-siterelated infections ( 7.4 versus 5.1 % , respectively , P=.61 ) , postoperative urinary tract infection , or other febrile morbidity . We conclude that short-term and long-term cefoxitin prophylaxis are equally effective for the prevention of postoperative surgical-site-related infections after radical hysterectomy
target: Results Prophylactic antibiotics  prevent inflammatory complications after gynaecological surgery .
  Prophylactic antibiotics are more effective in surgery requiring access to the peritoneal cavity or the vagina .
  Cefotetan appears to be more capable in preventing the overall inflammatory complication rate than cefoxitin or cefazolin .
  No benefit has been shown for the combination of antibiotics as prophylaxis .
  No difference has been shown between the long-term and short-term use of antibiotics .
  There is no need for the primary use of an anaerobic antibacterial agent .
  Conclusion Antibiotics help to prevent postoperative inflammatory complications after major gynecologic surgeries
background: Purpose The aim of this study was to systematic ally review the literature on antibiotic prophylaxis in gynaecologic surgeries to prevent inflammatory complications after gynaecological operations .