Antibiotics in acute abdominal surgery. A clinical trial comparing the combination of ampicillin, mecillinam and metronidazole with cefoxitin alone.

168 patients undergoing acute abdominal surgery for suspected peritoneal contamination were randomized consecutively to receive either a combination of ampicillin, mecillinam and metronidazole (group I) or cefoxitin (group II). Seventy-nine patients were evaluable in group I and 69 in group II. Postoperative surgical infections were seen in a total of 17 patients, 6 in group I (7.6%) and 11 in group II (15.9%). Evaluation of potential resistance development, side-effects and a trend towards better efficacy, together with a positive cost benefit analysis, have led us to adopt the combination of ampicillin, mecillinam and metronidazole as the standard treatment in cases of acute abdominal surgery. In the 18 months following the conclusion of the study, 263 patients undergoing acute abdominal surgery were treated with the triple combination. The infection rate in this material was 4.6%.