A comparative study between single dose Ceftriaxone as a prophylaxis versus conventional dose antibiotic in major gynaecological surgery in Dhaka Medical College Hospital, Dhaka, Bangladesh

Abstract

Introduction: Wound site infections are a major source of postoperative illness accounting for approximately a quarter of all nosocomial infections. The centers for Disease Control and prevention term for infections associated with surgical procedures were changed from surgical wound infection to surgical site infection. Objective: To establish the use of single-dose prophylactic injectable antibiotics as well as to compare the rate of wound infection among the gynae post-operative patients treated by only single-dose prophylactic versus conventional dose of antibiotics. Materials and Methods: This was a prospective study, carried out at Dhaka Medical College Hospital, Dhaka, Bangladesh during the period of July 2005 to May 2006. During this study period, 100 cases were taken for the study. The patients were divided into two groups. Group A: Fifty patients received 2 gm ceftriaxone i/v as prophylaxis 1 hour before the incision. Group B: Fifty patients received conventional therapy i.e. Ciprofloxacin and Metronidazole for 7 days. The data were matched for ages, weight, socio-economic condition, anemia, and for surgical procedure and technique. Incidence of infection and length of hospital stay were determined for each patient. Results: This study was done to establish the efficacy of single-dose injection Ceftriaxone prophylaxis in the prevention of surgical site infection. One hundred cases were randomly selected from the admitted patients for major gynecological surgery. The variables taken for analysis are age, weight, Hb%, duration of operation, wound infection, length of hospital stay, and the risk factors for infection. At the time of randomization, the above-mentioned characteristics of the cases in very both groups revealed little significant difference. With this aspect, it can be sketched that this comparative study was done in almost similar types of cases in two groups and the result was not affected by those minor variations. It was shown that about 52% of the patients were in 35-44 years in group-A and 58% were in the same age in Group-B. Fifty of them received 2g prophylactic Ceftriaxone. Another Fifty received the conventional therapy i.e. Ciprofloxacin & Metronidazole for 7 days. Wound infection was observed in 5 patients (10%) in Group-A and 6 patients (12%) in Group-B. There was no significant difference was observed in both groups. Patients with wound infection in both groups were treated according to the procedure described in the protocol. The study finding showed only a loading dose of 2g prophylactic injection Ceftriaxone if given as per protocol is as effective as the multi-drug regimen. But the prophylactic single-dose group was more beneficial due to their good compliance fewer side effects, cost-effectivity, and decrease the probability of drug resistance. Conclusion: At the discussion, the most recent studies about the prevention of SSI and prophylactic antibiotic were analyzed. It was seen that the whole world is very much concerned about the prevention of surgical site infection as well as antibiotic resistance. As both of them cause an adverse effect on the patient and cost more. It can be concluded that infection prevention is highly dependent on Antibiotic prophylaxis Administration of antibiotics depends.