Ceftriaxone and cefazolin prophylaxis for hysterectomy.

Two hundred and twenty-five women scheduled for elective hysterectomy were entered into a prospective, comparative, randomized, double-blind clinical trial of antibiotic prophylaxis; 117 had vaginal hysterectomy and 108 had abdominal hysterectomy. They were given a 1 gram preoperative dose of ceftriaxone, an investigational cephalosporin or three 1 gram parenteral doses of cefazolin over a 16 hour period. Antibiotic concentrations were measured in serum and vagina, myometrium, fallopian tube or ovary and mean ceftriaxone concentrations were consistently higher than those of cefazolin. Both regimens were safe, well tolerated and equally effective at preventing major postoperative infection. Diabetes increased the risk for infection regardless of regimen and surgical approach (p = 0.009) and specific risk factors were identified for women undergoing vaginal hysterectomy. The incidence of infection was 1.7 per cent after vaginal hysterectomy, significantly lower than the 7.4 per cent observed after abdominal hysterectomy (p = 0.039). Several of the clinical and surgical variables were identified that could explain this difference.