Antibiotics in Penetrating Abdominal Trauma

ă Copyright Eastern Association for the Surgery of Trauma, 1998

PROPHYLACTIC ANTIBIOTICS IN PENETRATING ABDOMINAL TRAUMA:

LITERATURE REVIEW - OUTCOME

Data

Conclusions

First Author	Year	Reference	Class	Antibiotics	# Pts	Duration (Days)	Organs*	% Infected
O’Donnell V	1978	Evaluation of Carbenicillin and a comparison of Clindamycin and Gentamicin combined therapy in penetrating abdominal trauma. *S,G&O* 147: 525 (5)	II	Clindamycin + Gentamicin Carbenicillin	66 60	no injury Ł 4 any injury ł 6	colon 15 colon 15	16 21
O'Donnell VA	1978	Role of antibiotics in penetrating abdominal trauma. *Am Surg* 44: 574 (6)	III	Cephalosporin/ Penicillin/ Chloramphenicol Gentamicin, Kanamycin, Clindamycin, Gentamicin + Clindamycin	107	variable _ 7	N/A N/A	15.8 7.4
Fabian TC	1982	Use of antibiotic prophylaxis in penetrating abdominal trauma. *Clin Ther* 5: 38 (7)	I	Cefotaxime Cefotaxime Cefazolin	117 127 116	<1 1 1	colon 19 hv 45 colon 19 hv 41 colon 16 hv 32	17 10 9
Oreskovich MR	1982	Duration of preventive antibiotic administration for penetrating abdominal trauma. *Arch Surg* 117: 200 (8)	I	Penicillin G + Doxycycline	42 39	12 hrs 5	colon 9 hv 17 colon 9 hv 12	26 15
Crenshaw C	1983	A prospective random study of a single agent versus combination antibiotics as therapy in penetrating injuries of the abdomen. *S,G&O* 156: 289 (9)	II	Cefamandole Tobramycin + Cephalothin	49 45	_ 3	colon 16 colon 16	6 11

Data

Conclusions

First Author	Year	Reference	Class	Antibiotics	# Pts	Duration (Days)	Organs*	% Infected
Moore FA	1983	Preoperative antibiotics for abdominal gunshot wounds. *Am J Surg* 146: 762 (10)	I	Ampicillin + Clindamycin + Amikacin Penicillin + Doxycycline Carbenicillin	30 26 30	5 for colon 2 hv 1 no injury	colon 15 hv 24 colon 12 hv 20 colon 12 hv 23	20 23 13
Dellinger EP	1984	Risk of infection following laparotomy for penetrating abdominal injury. *Arch Surg* 119: 2 (11)	III	Penicillin + Tetracycline Or Doxycycline	330	N/A	colon 78 hv 118	13
Gentry LO	1984	Perioperative antibiotic therapy for penetrating injuries of the abdomen. *Ann Surg* 200: 561 (12)	II	Cefamandole Cefoxitin Ticarcillin + Tobramycin	51 50 51	2 2 2	colon 22 sb 37 colon 21 sb 40 colon 26 sb 37	18 6 10
Hofstetter SR	1984	A prospective comparison of two regimens of prophylactic antibiotics in abdominal trauma: Cefoxitin versus triple drug. *J Trauma* 24: 307 (13)	II	Cefoxitin Ampicillin + Clindamycin + Aminoglycoside	69 50	1 1	hv 31 hv 25	14 18
Nichols RL	1984	Risk of infection after penetrating abdominal trauma. *NEJM* 311: 1065 (14)	I	Cefoxitin + placebo Clindamycin + Gentamycin	70 75	5	colon 40 sb 30 colon 35 sb 40	24 24

Rowlands BJ

1984

Comparative studies of antibiotic therapy after penetrating abdominal trauma.

Am J Surg 148: 791 (15)

Cefamandole

Cefoxitin

Clindamycin +

Tobramycin

Moxalactam

Clindamycin +

Tobramycin

N/A

Data

Conclusions

First Author	Year	Reference	Class	Antibiotics	# Pts	Duration (Days)	Organs*	% Infected
Fabian TC	1985	Antibiotics in penetrating abdominal trauma. *Am J Med* 79: 157 (16)	II	Gentamicin + Clindamycin Ticarcillin / Clavulanate	32 53	1 1	all all	13 2
Jones RC	1985	Evaluation of antibiotic therapy following penetrating abdominal trauma. *Ann Surg* 201: 576 (17)	I	Tobramycin + Clindamycin Cefamandole Cefoxitin	85 78 94	2 2 2	colon 39 hv 61 colon 26 hv 55 colon 31 hv 64	29 36 18
Lou MA	1985	Comparison of Cefamandole and Carbenicillin in preventing sepsis following penetrating abdominal trauma. *Am Surg* 51: 580 (18)	II	Cefamandole Carbenicillin	47 58	3 or 5	colon 13 hv 33 colon15 hv 36	6.4 19
Dellinger EP	1986	Efficacy of short-course antibiotic prophylaxis after penetrating intestinal injury. *Arch Surg* 121: 23 (19)	II	Doxycycline + Penicillin G Cefoxitin Doxycycline + Penicillin G Cefoxitin	31 30 25 28	12 hrs 12 hrs 5 5	colon 18 sb 13 colon 15 sb 15 colon 14 sb 11 colon 14 sb 14	16 17 24 11
Feliciano DV	1986	Single agent Cephalosporin prophylaxis for penetrating abdominal trauma. *Am J Surg* 152: 674 (20)	II	Cefotaxime Cefoxitin Moxalactam	124 149 153	2 2 2	colon 52 hv 101 colon 65 hv 117 colon 66 hv 111	2 13 7
Heseltine PNR	1986	The efficacy of Cefoxitin vs. Clindamycin/Gentamicin in surgically treated stab wounds of the bowel. *J Trauma* 26: 241 (21)	I	Gentamicin + Clindamycin Cefoxitin	41 34	_3	colon 14 hv 27 colon 7 hv 27	7 3

			Data	Conclusions
First Author	Year	Reference	Class	Antibiotics	# Pts	Duration (Days)	Organs*	% Infected
Kreis DJ, Jr.	1986	A prospective randomized study of Moxalactam versus Gentamicin and Clindamycin in penetrating abdominal trauma. *S,G&O* 163: 1 (22)	II	Gentamycin + Clindamycin Moxalactam	22 20	>3	colon 2 hv 4 colon 2 hv 7	23 0
Nelson RM	1986	Single-antibiotic use for penetrating abdominal trauma. *Arch Surg* 121: 153 (23)	I	Tobramycin + Clindamycin Moxalactam	85 78	5 5	colon 26 hv 54 colon 30 hv 50	11 16
Posner MC	1987	Presumptive antibiotics for penetrating abdominal wounds. *S,G&O* 165: 29 (24)	II	Mezlocillin Clindamycin + Gentamycin	61 69	colon 5 hv 2	colon 14 colon 19	15 13
Rowlands BJ	1987	Penetrating abdominal trauma: The use of operative findings to determine length of antibiotic therapy. *J Trauma* 27: 250 (25)	II	Tobramycin + Metronidazole Tobramycin + Clindamycin Tobramycin + Metronidazole Tobramycin + Clindamycin	49 53 31 27	3 3 <1 <1	colon 21 sb 19 colon 32 sb 14 colon 1 sb 1 colon 0 sb 0	16 25 6 0
Fifer T	1988	A prospective randomized comparison of a single antibiotic (Moxalactam) versus combination therapy (Gentamicin and Clindamycin) in penetrating abdominal trauma. *Henry Ford Hosp Med J* 36:52(26)	II	Gentamicin + Clindamycin Moxalactam	25 25	ł 3 _ 3	colon 4 hv 12 colon 2 hv 11	0 0
Lou MA	1988	Safety and efficacy of mezlocillin: A single-drug therapy for penetrating abdominal trauma. *J Trauma* 28: 1541 (27)	II	Mezlocillin Clindamycin + Gentamicin	74 73	colon 5-10 hv 2-10 no injury 1	colon 20 hv 49 colon 24 hv 48	9 10

			Data	Conclusions
First Author	Year	Reference	Class	Antibiotics	# Pts	Duration (Days)	Organs*	% Infected
Ericsson CD	1989	Prophylactic antibiotics in trauma: The hazards of under dosing. *J Trauma* 29: 1356 (28)	II	Amikacin + Clindamycin 1200 Amikacin + Clindamycin 1200 Amikacin + Clindamycin 600	47 52 51	1 3 3	colon 13 colon 14 colon 18	19 21 12
Moore FA	1989	Presumptive antibiotics for penetrating abdominal wounds. S,G&O 169: 99 (29)	II	Mezlocillin Gentamycin + Clindamycin	136 142	colon 5 hv 2	colon 31 colon 35	15 13
Demetraides D	1991	Short-course antibiotic prophylaxis in penetrating abdominal injuries: Ceftriaxone versus Cefoxitin. *Injury* 22: 20 (30)	II	Ceftriaxone Cefoxitin	60 63	colon 2 hv 1	colon 12 hv 38 colon 13 hv 45	7 8
Rensburg LCJ	1991	Ceftriaxone (Rocephin) in abdominal trauma. *J Trauma* 31: 1490 (31)	II	Ceftriaxone + Metronidazole	290 (89% stabs	1	colon 47 hv 129	1.4 all infections, 0 deep
Fabian TC	1992	Duration of antibiotic therapy for penetrating abdominal trauma: A prospective trial. *Surgery* 112: 778 (32)	I	Cefoxitin Cefotetan Cefoxitin Cefotetan	135 130 117 133	1 1 5 5	colon 28 colon 28 colon 26 colon 29	11 6 7 13
Griswold JA	1993	Injury severity dictates individualized antibiotic therapy in penetrating abdominal trauma. *Am Surg* 59: 34 (33)	I	Cefoxitin Ceftizoxime Mezlocillin Cefoxitin Ceftizoxime Mezlocillin	25 23 20 6 13 15	6 or 12 hrs Primary repair, no shock, < 3 organs 6 or 12 hrs Colostomy, shock, ł 3 organs	colon 5 colon 3 colon 3 colon 5 colon 3 colon 5	12 8.7 10 50 15 53
Sims EH	1993	Piperacillin monotherapy compared with Metronidazole and Gentamicin combination in penetrating abdominal trauma. *J Trauma* 34: 205 (34)	II	Gentamicin + Metronidazole Piperacillin	89 33 94 30	5-15 2 5-15 2	colon 20 hv 40 colon 26 hv 49	8 0 7 0

			Data	Conclusions
First Author	Year	Reference	Class	Antibiotics	# Pts	Duration (Days)	Organs*	% Infected
Fabian TC	1994	Superiority of Aztreonam/Clindamycin compared with Gentamicin/Clindamycin in patients with penetrating abdominal trauma. *Am J Surg* 167: 291 (35)	I	Gentamicin + Clindamycin Aztreonam + Clindamycin	36 37	4 1 4 1	colon 9 hv 27 colon 8 hv 29	13 3
Sims EH	1997	How many antibiotics are necessary to treat abdominal trauma victims? *Am Surg* 63: 525 (36)	I	Cefoperazone Ceftriaxone + Metronidazole Ampicillin + Gentamicin + Metronidazole	101 95 95	All _ 5	colon 29 hv 53 colon 25 hv 53 colon 37 hv 69	8 2 5

PROPHYLACTIC ANTIBIOTICS IN PENETRATING ABDOMINAL TRAUMA:

LITERATURE REVIEW - PHARMACOKINETICS AND COST

			Data	Conclusions
First Author	Year	Reference	Class	Antibiotics	# Pts	Duration (Days)	Lab Test	Cost Analysis
Crots LD	1985	Twice-daily moxalactam versus gentamicin and Clindamycin in patients with penetrating abdominal trauma. *Clin Pharm* 4: 316 (37)	II	Clindamycin + Gentamicin Moxalactam	25 25	5.4 6.0	165 173	$ 475.11 $ 331.88
Bivins BA	1988	Preventive antibiotics for penetrating abdominal trauma - Single agent or combination therapy. *Drugs* 35: 100 (38)	II	Cefotaxime Cefoxitin Clindamycin + Gentamycin	25 25 25	3 - 98 3 - 98 3 - 98	170 185 158	$ 471.90 $ 530.24 $ 528.54
Bivins BA	1989	Antibiotics for penetrating abdominal trauma: A prospective comparative trial of single agent cephalosporin therapy versus combination therapy. *Diagn Microbiol Infect* 12:113 (39)	II	Cefotaxime Cefoxitin Clindamycin + Gentamicin		Mean 5 Mean 4 Mean 6	N/A N/A 108	$ 382.77 $ 404.95 $ 594.55

Hooker KD

1991

Aminoglycoside combinations versus beta-lactams alone for penetrating abdominal trauma: A meta-analysis.

J Trauma 31:1155 (40)

III

Meta-analysis performed of 17 randomized studies to assess effectiveness of single versus combinations containing aminoglycoside when used for penetrating abdominal wounds. Concluded single beta-lactam antimicrobials are as effective as traditional combinations including aminoglycoside.

Reed RL

1992

The pharmacokinetics of

prophylactic antibiotics in trauma.

J Trauma 32: 21 (41)

Clindamycin +

Amikacin

(Uniform Dose)

Clindamycin +

Amikacin

(AdjustedDose)

None

Peak and

Trough

Variations in

volume of dis-

tribution cause

nontherapeutic

levels with

standard doses.

			Data	Conclusions
First Author	Year	Reference	Class	Antibiotics	# Pts	Duration (Days)	Lab Test	Cost Analysis

Rosemurgy AS

1995

Ceftizoxime use in trauma celiotomy: Pharmacokinetics and patient outcomes.

J Clin Pharmacol 35: 1046 (42)

Ceftizoxime

11% devel-

oped infect-

ions. All had signifi-

cantly less volume

distribution.

N/A

Fabian TC

1996

Pharmacoeconomics of aztreonam-Clindamycin versus gentamicin-Clindamycin in the treatment of penetrating abdominal injury.

Pharmacotherapy 16: 951 (43)

Gentamicin +

Clindamycin

Aztreonam +

Clindamycin

4 (colon) or 1

Mean hos-

pital cost:

$66,336

$ 8,014

14.6

2.3

CLASS I DATA: COMBINATION VERSUS SINGLE AGENT

Data

Conclusions

First Author

Year

Reference

Class

Antibiotics

# Pts

Duration (Days)

Organs*

% Infected

Fabian TC

1982

Use of antibiotic prophylaxis in

penetrating abdominal trauma.

Clin Ther 5: 38 (7)

Cefotaxime

Cefazolin

117

127

116

colon 19

hv 45

colon 19

hv 41

colon 16

hv 32

Oreskovich

1982

Duration of preventive antibiotic

administration for penetrating

abdominal trauma.

Arch Surg 117: 200 (8)

Penicillin G +

Doxycycline

12 hrs

colon 9

hv 17

colon 9

hv 12

Nichols RL

1984

Risk of infection after

penetrating abdominal trauma.

NEJM 311: 1065 (14)

Cefoxitin +

placebo

Clindamycin +

Gentamycin

colon 40 sb 30

colon 35

sb 40

Jones RC

1985

Evaluation of antibiotic therapy

following penetrating abdominal

trauma.

Ann Surg 201: 576 (17)

Tobramycin +

Clindamycin

Cefamandole

Cefoxitin

colon 39

hv 61

colon 26

hv 55

colon 31

hv 64

Heseltine PNR

1986

The efficacy of Cefoxitin vs.

Clindamycin/Gentamicin in

surgically treated stab wounds

of the bowel.

J Trauma 26: 241 (21)

Gentamicin +

Clindamycin

Cefoxitin

colon 14

hv 27

colon 7

hv 27

Nelson RM

1986

Single-antibiotic use for

penetrating abdominal trauma.

Arch Surg 121: 153 (23)

Tobramycin +

Clindamycin

Moxalactam

colon 26

hv 54

colon 30

hv 50

Data

Conclusions

First Author

Year

Reference

Class

Antibiotics

# Pts

Duration (Days)

Organs*

% Infected

Fabian TC

1992

Duration of antibiotic therapy

for penetrating abdominal

trauma: A prospective trial.

Surgery 112: 778 (32)

Cefoxitin

Cefotetan

Cefoxitin

Cefotetan

135

130

117

133

colon 28

colon 26

colon 29

Griswold JA

1993

Injury severity dictates

individualized antibiotic

therapy in penetrating

abdominal trauma.

Am Surg 59: 34 (33)

Cefoxitin

Ceftizoxime

Mezlocillin

Cefoxitin

Ceftizoxime

Mezlocillin

6 or 12 hrs

Primary repair, no

shock, < 3organs

6 or 12 hrs

Colostomy, shock, ł 3 organs

colon 5

colon 3

colon 5

colon 3

colon 5

8.7