Kreis D J, Augenstein D, Martinez O, Echenique M, Plasencia G, Vopal J J, Byers P, Gomez G A
Surg Gynecol Obstet. 1986 Jul;163(1):1-4.
We conducted a randomized, prospective study of moxalactam versus gentamicin plus clindamycin in 42 patients with penetrating abdominal trauma. Patients were randomized to receive intravenously either 2 grams of moxalactam every 12 hours or 80 milligrams of gentamicin every eight hours and 600 milligrams of clindamycin every six hours. Antibiotics were administered preoperatively and continued for a minimum of five days if hollow viscus injury occurred. For those without hollow viscus injury, only those patients receiving a minimum of three days of antibiotics were evaluated. A single intramuscular dose of 10 milligrams of vitamin K was also administered to all patients in the moxalactam group. There were 39 males and three females with a mean age of 33 years. Twenty patients received moxalactam and 22 received gentamicin plus clindamycin. The mechanism of injury was gunshot wound in 32 patients and stab wounds in ten patients. Eight patients in each group sustained injuries to the small intestine or colon, or both. The mean injury severity score was 22.6 and 21.2 in the single and double antibiotic regimen, respectively. The mean duration of antibiotic therapy was 5.8 and 7.0 days in the single and double antibiotic group, respectively. No infectious complications occurred in the moxalactam group whereas five infections occurred in four patients in the gentamicin plus clindamycin group (p less than 0.05). These infections included one intra-abdominal abscess, two wound infections and two episodes of necrotizing fasciitis of the wound and abdominal wall. There were no complications attributable to moxalactam therapy. The over-all mortality rate was zero per cent. The total pharmacy cost of a five day course of moxalactam plus a single dose of vitamin K is $204.67 compared with $226.00 for a similar course of gentamicin plus clindamycin. We conclude that: moxalactam is at least, if not more, effective in preventing infectious complications after penetrating abdominal trauma compared with gentamicin plus clindamycin; moxalactam is safe in the doses used when combined with vitamin K, and 3, moxalactam is more cost-effective than gentamicin plus clindamycin dual antibiotic therapy.
我们对42例腹部穿透伤患者进行了一项关于头孢氧哌唑与庆大霉素加克林霉素的随机前瞻性研究。患者被随机分组，分别接受每12小时静脉注射2克头孢氧哌唑，或每8小时静脉注射80毫克庆大霉素加每6小时静脉注射600毫克克林霉素。术前给予抗生素治疗，若发生中空脏器损伤，则至少持续使用5天。对于未发生中空脏器损伤的患者，仅对使用抗生素至少3天的患者进行评估。头孢氧哌唑组的所有患者还均接受了一次10毫克维生素K的肌肉注射。研究对象包括39例男性和3例女性，平均年龄33岁。20例患者接受头孢氧哌唑治疗，22例患者接受庆大霉素加克林霉素治疗。致伤机制为枪伤32例，刺伤10例。每组各有8例患者发生小肠或结肠损伤，或两者均有损伤。单药及联合用药方案组的平均损伤严重度评分分别为22.6和21.2。单药及联合用药组的抗生素平均治疗时长分别为5.8天和7.0天。头孢氧哌唑组未发生感染性并发症，而庆大霉素加克林霉素组有4例患者发生了5次感染（p<0.05）。这些感染包括1例腹腔脓肿、2例伤口感染以及2例伤口及腹壁坏死性筋膜炎。未出现与头孢氧哌唑治疗相关的并发症。总体死亡率为0%。一个为期5天的头孢氧哌唑疗程加单剂量维生素K的药房总成本为204.67美元，而类似疗程的庆大霉素加克林霉素的成本为226.00美元。我们得出结论：与庆大霉素加克林霉素相比，头孢氧哌唑在预防腹部穿透伤后感染性并发症方面至少同样有效，甚至可能更有效；头孢氧哌唑与维生素K联合使用时，所用剂量安全；3. 头孢氧哌唑比庆大霉素加克林霉素的联合抗生素治疗更具成本效益。
