Three-Dose Cefmetazole May Be Better Than a Single Dose for Colorectal Surgery

July 19, 2007 — Three-dose cefmetazole administration is significantly more effective for prevention of incisional surgical site infection (SSI) than single-dose administration for patients undergoing colorectal surgery, according to the results of a prospective randomized trial published in the July issue of Archives of Surgery.
"Use of prophylactic antibiotics in elective colorectal surgery is essential," write Shin Fujita, MD, from the National Cancer Center Hospital in Tokyo, Japan, and colleagues. "Although single-dose prophylactic antibiotics are recommended, the efficacy of single-dose cephalosporin without metronidazole and oral antibiotics is not fully proven. We conducted a multicenter, randomized trial of a single dose vs 3 doses of the second-generation cephalosporin cefmetazole."
At 7 major hospitals in Japan that offer cancer treatment, patients with colorectal cancer undergoing elective colorectal surgery from May 6, 2004, to April 25, 2005, were randomized to a single-dose group given a single dose of cefmetazole just before skin incision or a 3-dose group given 2 additional doses of cefmetazole every 8 hours after the first dose just before skin incision.
Primary endpoints were rates of incisional SSI, organ or space SSI, and all other infectious complications within 30 days after surgery.
Of 384 patients enrolled, 7 were excluded because of additional surgery or the inability to tolerate mechanical preparation. Compared with the 3-dose group, the single-dose group had a higher incidence of incisional SSI (27 [14.2%] of 190 vs 8 [4.3%] of 187; P = .009).
Both groups had similar rates of organ or space SSI and other postoperative infectious diseases. Multivariate analysis revealed that antibiotic dose was the only significant factor related to the incidence of incisional SSI.
Study limitations include lack of double blinding and of placebo control.
"If oral antibiotics and metronidazole are not used for prophylaxis in patients undergoing colorectal surgery, administration of the 3-dose second generation cephalosporin cefmetazole is significantly more effective for prevention of incisional SSI than single-dose antibiotic administration regardless of patient age, sex, tumor site, type of surgery, operative time, or operative blood loss," the authors conclude. "Prevention of incisional SSI is important for reducing the period of hospitalization and thus cost. Our results indicate that a single dose of prophylactic antibiotics does not always save costs."
A Grant-in-Aid for Cancer Research from the Ministry of Health, Labor and Welfare of Japan supported this study. The authors have disclosed no relevant financial relationships.
Arch Surg. 2007;142:657-661.