Comparative evaluation of cefotaxime and cephamandole in the prevention of post-operative infective complications following emergency abdominal surgery.

In previous published work we described 57 patients undergoing emergency abdominal surgery, prospectively randomised to receive either cefotaxime or cephamandole as a single-antibiotic, three-dose, peri-operative prophylaxis against post-operative infective complications. This earlier work suggested that cefotaxime might be more effective than cephamandole in preventing wound sepsis in emergency abdominal surgery. We describe here our findings in a further 63 patients undergoing emergency abdominal surgery who were similarly allocated into either a cefotaxime or cephamandole antibiotic group. Infective complications occurred in 12/32 (37 per cent) of the cefotaxime group and 15/31 (48 per cent) of the cephamandole group. Wound infections occurred in 5/32 (16 per cent) of the cefotaxime group and 9/31 (29 per cent) of the cephamandole group. The organisms cultured and their sensitivities are discussed in detail. The total of 120 patients studied in the two series showed wound infection to occur in 13 per cent of the 62 patients receiving cefotaxime and 30 per cent of the 58 patients receiving cephamandole. This difference reaches statistical significance (p less than 0.05). Possible mechanisms to explain this finding are discussed. Again we found the regime of 4 g of cefotaxime given peri-operatively to be a simple, safe and effective single agent as prophylaxis for emergency abdominal surgery.