Woodfield John C, Van Rij Andre M, Pettigrew Ross A, van der Linden Antje J, Solomon Clive, Bolt Donna
Department of Surgery, Dunedin School of Medicine, University of Otago, P.O. Box 913, Dunedin, New Zealand.
Am J Surg. 2003 Jan;185(1):45-9. doi: 10.1016/s0002-9610(02)01125-x.
Although ceftriaxone (R) and cefotaxime (C) are highly effective antibiotics, few studies have directly compared their prophylactic efficacy.
In a prospective, randomized, double blind study of 1,013 patients undergoing abdominal surgery, the prophylactic use of ceftriaxone and cefotaxime were compared. Intravenous cephalosporin, 1 g, was given at induction of anesthesia, with intravenous metronidazole, 500 mg, also being given for colorectal surgery.
The difference in wound infection (R 8%, C 12%, P <0.05) was due to appendicectomies not receiving metronidazole, (R 6%, C 18%, P <0.03) and was no longer present when these cases were excluded from analysis (R 8%, C 10%). Of note chest and urinary tract infection (R 6%, C 11%, P <0.02) and "any" infection (R 20%, C 27%, P <0.05) were reduced with ceftriaxone.
Both antibiotics provide comparable wound prophylaxis as long as metronidazole is added for colorectal and appendiceal surgery. Ceftriaxone may be more versatile having the additional apparent benefits of reducing other postoperative infections, being less dependent on metronidazole as an adjunct and providing a more effective prophylactic cover against Staphylococcus aureus.
尽管头孢曲松（R）和头孢噻肟（C）是高效抗生素，但很少有研究直接比较它们的预防效果。
在一项对1013例接受腹部手术患者的前瞻性、随机、双盲研究中，比较了头孢曲松和头孢噻肟的预防性使用情况。在麻醉诱导时静脉给予1g头孢菌素，对于结直肠手术还静脉给予500mg甲硝唑。
伤口感染率的差异（R组8%，C组12%，P<0.05）是由于阑尾切除术患者未接受甲硝唑（R组6%，C组18%，P<0.03），当这些病例被排除在分析之外时差异不再存在（R组8%，C组10%）。值得注意的是，头孢曲松降低了胸部和尿路感染率（R组6%，C组11%，P<0.02）以及“任何”感染率（R组20%，C组27%，P<0.05）。
只要在结直肠和阑尾手术中添加甲硝唑，两种抗生素提供的伤口预防效果相当。头孢曲松可能更具通用性，具有减少其他术后感染的额外明显益处，对甲硝唑作为辅助药物的依赖性较小，并且对金黄色葡萄球菌提供更有效的预防性覆盖。
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