Effectiveness of Ceftriaxone Versus Cefoxitin in Reducing Chest and Wound Infections After Upper Abdominal Operations

A controlled randomized trial with blind assessment of end results is described comparing the efficacy of 1 g of intravenous ceftriaxone at induction of anesthesia with 1 g of intravenous cefoxitin (three times) administered every 8 hours starting at induction in preventing pulmonary and wound infection after upper abdominal operations. There were 150 adults who underwent biliary or gastroduodenal operations who were randomized to each protocol. A total of 123 patients completed the protocol--59 received ceftriaxone and 64 cefoxitin. Chest infection was defined as pyrexia plus clinical and/or radiologic signs of consolidation or the production of purulent sputum. Wound infection was defined as purulent wound discharge. There was a significant reduction (19% versus 42%, P < 0.05) in chest complications and in wound infection (0% versus 8%, P < 0.05) in the ceftriaxone group compared with the cefoxitin group. It is concluded that for biliary and gastroduodenal operations, 1 g of ceftriaxone is superior to 1 g of cefoxitin (three times) administered every 8 hours and that this effect is likely to be due to the prolonged bactericidal blood levels produced by a single dose of ceftriaxone.