Summary
The efficacy and safety of perioperative prophylaxis with sulbactam-ampicillin or cefoxitin was compared in a prospective randomized double-blind study of 103 patients undergoing transurethral surgery. Fifty-two patients received 0.5 g sulbactam and 1 g ampicillin intramuscularly, 30 to 90 minutes prior to surgery, followed by the same dose administered intravenously every eight hours for a total of three additional doses over 24 hours. Fifty-one patients received 1 g of cefoxitin administered according to the same schedule as sulbactam-ampicillin. The incidence of urinary tract infection during hospitalization was 8% in the sulbactam-ampicillin group and 4% in the cefoxitin group. One month postoperatively the incidences were 3% and 5%, respectively. There was no significant difference between the groups in incidence of fever or length of postoperative hospital stay. Both drugs were well tolerated. No side effects were seen other than a mild skin rash in one patient and diarrhea in two patients. Sulbactam concentrated in prostatic tissue, and ampicillin together with sulbactam was found in concentrations above the minimal inhibitory concentration of most bacteria causing postoperative urinary tract infection. It is concluded that sulbactam-ampicillin and cefoxitin are equally effective and safe in preventing postoperative urinary tract infection in transurethral surgery.
Zusammenfassung
In einer prospektiven randomisierten Doppelblindstudie mit 103 Patienten, die einen transurethralen chirurgischen Eingriff durchmachten, wurde die Wirksamkeit und Sicherheit einer perioperativen Prophylaxe mit Sulbactam-Ampicillin und Cefoxitin verglichen. 52 Patienten erhielten 0,5 g Sulbactam und 1 g Ampicillin i. m. 30–90 Minuten vor der Operation und nach der Operation nochmals drei zusätzliche Dosen entsprechender Menge i.v. im Abstand von acht Stunden, über einen Gesamtzeitraum von 24 Stunden. In einem entsprechenden Applikationsschema wurde 51 Patienten jeweils 1 g Cefoxitin verabreicht. In der Sulbactam-Ampicillin-Gruppe betrug die Inzidenz an Harnwegsinfektionen während der stationären Behandlung 8%, in der Cefoxitin-Gruppe 4%. Einen Monat nach der Operation lagen die Inzidenzen bei 3% bzw. 5%. In der Inzidenz von Fieber oder der Dauer des postoperativen Krankenhausaufenthaltes bestanden keine signifikanten Unterschiede zwischen den Gruppen. Beide Medikamente wurden gut vertragen. Mit Ausnahme eines leichten Exanthems bei einem Patienten und Durchfall bei zwei Patienten wurden keine Nebenwirkungen beobachtet. Sulbactam reicherte sich im Prostatagewebe an; die Konzentrationen von Ampicillin und Sulbactam lagen oberhalb der minimalen Hemmkonzentrationen der meisten für postoperative Harnwegsinfektionen in Frage kommenden Bakterien. Aus den Befunden wird abgeleitet, daß Sulbactam-Ampicillin und Cefoxitin von gleicher Wirksamkeit und Sicherheit für die Prävention von Harnwegsinfektionen bei transurethralen chirurgischen Eingriffen sind.
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Dørflinger, T., Madsen, P.O. Antibiotic prophylaxis in transurethral surgery: A comparison of sulbactam-ampicillin and cefoxitin. Infection 13, 66–69 (1985). https://doi.org/10.1007/BF01660416
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DOI: https://doi.org/10.1007/BF01660416