Randomized, double-blind comparison of cefotaxime, cefoxitin, cefazolin or placebo as prophylaxis during gastric, small bowel or complicated biliary surgery.

In a double-blinded trial, 142 patients were randomized to receive placebo, cefazolin, cefoxitin or cefotaxime during high-risk gastroduodenal, biliary tract or small bowel surgery. Of the 125 evaluable patient trials, postoperative wound infection or intra-abdominal sepsis developed in 14/29 (48%) of placebo controls, 8/24 (33%) cefazolin, 7/37 (19%) cefoxitin, and in 2/35 (6%) of cefotaxime recipients. When patients undergoing vagotomy and pyloroplasty with prior cimetidine therapy were excluded, cefotaxime was superior to cefoxitin prophylaxis (2/26 versus 7/28, P = 0.014). Cefotaxime may be useful as a prophylactic agent in high-risk upper gastrointestinal surgery.