Tanos V, Rojansky N
Department of Obstetrics and Gynecology, Hadassah Ein-Kerem Medical Center, Jerusalem, Israel.
J Am Coll Surg. 1994 Nov;179(5):593-600.
The cephalosporins, which have been widely used in gynecologic surgery, are considered by many to be the drug of choice for chemoprophylaxis. However, their benefit in total abdominal hysterectomy has remained controversial. This study was done to evaluate the effectiveness of the commonly used cephalosporins in preventing inflammatory complications which may occur after elective abdominal hysterectomy.
A MEDLINE and manual review of the literature from the past 15 years (1977 to 1991), using the terms "prophylactic antibiotics," "abdominal hysterectomy," and "cephalosporins," was performed. Seventeen prospective trials using cephalosporin prophylaxis alone for 24 hours perioperatively were evaluated. A meta-analysis of the 2,752 study and control patients abstracted was performed to compare postoperative infection and febrile morbidity rates.
The cephalosporin group as well as the various generations and individual drugs were found to be useful in preventing postoperative infection (p < 0.001). Febrile morbidity, however, was effectively prevented (p < 0.001) by first but not by some second and third generation drugs. Multivariate analysis revealed no advantage for the newer, more expensive second and third generation cephalosporins studied. When adjusted for confounding factors, the number of doses, the amount of the dose, and the route of administration had significant impact on the outcome events.
Chemoprophylaxis with cephalosporins was found to be effective in preventing posthysterectomy infectious complications. A single dose, preoperative injection of first (cefazolin) or second (cefoxitin) generation cephalosporin, when administrated intravenously, has been shown to yield the best, cost-effective clinical results.
头孢菌素已广泛应用于妇科手术，许多人认为它是化学预防的首选药物。然而，其在全腹子宫切除术中的益处仍存在争议。本研究旨在评估常用头孢菌素在预防择期腹式子宫切除术后可能发生的炎症并发症方面的有效性。
利用“预防性抗生素”“腹式子宫切除术”和“头孢菌素”等关键词，对过去15年（1977年至1991年）的文献进行了医学文献数据库（MEDLINE）检索和手工检索。对17项仅在围手术期使用头孢菌素预防24小时的前瞻性试验进行了评估。对提取的2752例研究患者和对照患者进行荟萃分析，以比较术后感染率和发热发病率。
发现头孢菌素组以及各代头孢菌素和个别药物在预防术后感染方面均有用（p < 0.001）。然而，第一代头孢菌素能有效预防发热发病率（p < 0.001），而一些第二代和第三代头孢菌素则不能。多变量分析显示，所研究的更新、更昂贵的第二代和第三代头孢菌素并无优势。在对混杂因素进行调整后，剂量数量、剂量大小和给药途径对结局事件有显著影响。
发现头孢菌素化学预防在预防子宫切除术后感染并发症方面是有效的。术前静脉注射单剂量第一代（头孢唑林）或第二代（头孢西丁）头孢菌素已被证明能产生最佳的、具有成本效益的临床效果。
