Antibiotic prophylaxis in high risk biliary surgery: one dose of ceftriaxone compared with two doses of cefuroxime

In a controlled trial 219 high risk patients undergoing biliary surgery were allocated at random by sealed envelopes to one of two treatment groups. Group I (n = 112) received a single dose ceftriaxone 1 g intravenously at the time of skin incision, and group II (n = 107) was given cefuroxime 1.5 g intravenously at the time of skin incision, followed by a second dose eight hours later. There were no significant differences between groups in age, sex, diagnosis, or operations carried out. There were three wound infections in group I (3%) and four in group II (4%) (p = 0.65). One patient in group I and two patients in group II developed intra-abdominal abscess and septicaemia (0.9% and 1.9%, respectively). Five patients developed pneumonia postoperatively in group I (5%) and six in group II (6%) (p = 0.65). There was no significant difference of the total number of postoperative infectious complications (wound infection, intraabdominal abscess, septicaemia, and pneumonia) between the groups (p = 0.42). A single dose of ceftriaxone given intravenously at skin incision was as effective as two doses of cefuroxime for the prophylaxis of wound infection in this high risk group of patients.