Prophylactic antibiotic therapy with cefamandole and tobramycin for patients undergoing renal transplantation.

The incidence of infections among patients undergoing renal transplantation has been reported as high as 83% during the first post-transplant year. In an effort to reduce the occurrence of such infections, we evaluated the role of perioperative prophylactic antibiotics in these patients. Thirty-seven patients undergoing transplantation were assigned randomly to treatment groups (N = 20, cefamandole, 1 gm IM every 6 hrs for 8 doses/tobramycin 1 mg/kg IM for 1 dose, starting 2 hrs prior to surgery) and control groups (N = 17, no antibiotics). A uniform infection surveillance system was used. Eighty-one percent (30/37) of patients became infected; 70% (14/20) of treated patients and 94% (16/17) of controls (p = 0.14). Since antibiotic prophylaxis might be expected to exert the greatest influence in the immediate postoperative period, we examined patient outcome data for both the first seven posttransplant days and for the entire hospitalization. Of the 38% (14/37) of patients who developed infections during the first posttransplant week, a statistically greater proportion came from the control group than from the treated group (10/17 vs. 4/20, p = 0.04). These data suggest that this regimen is effective in reducing the occurrence of infections during the first week following renal transplantation.