Comparing a combination of penicillin G and gentamicin to a combination of clindamycin and amikacin as prophylactic antibiotic regimens in prevention of clean contaminated wound infections in cancer surgery

Abstract EN

Background and aim : Appropriate antibiotic selection and timing of administration for prophylaxis are crucial to reduce the likelihood of surgical site infection (SSI) after a clean contaminated cancer surgery.

Our aim is to compare the use of two prophylactic antibiotic (PA) regimens as regards efficacy, timing, and cost.

Patients and methods: Two hundred patients with gastric, bladder, or colorectal cancer were randomized to receive preoperative PA, group a received penicillin G sodium and gentamicin and group B received clindamycin and amikacin intravenously.

The demographic data of patients were collected, and they were observed for wound infections.

Results : Infected wounds occurred in 19 patients with a rate of 9.5 %.

Highest incidence of SSI was among bladder cancer patients (14.2 %) ; p = 0.044.

The rate of SSI was 11 % in group A, and 8 % in group B, p = 0.469.

The cost of PA administered in group A was significantly less than that of group B (21.96 ± 3.22 LE versus 117.05 ± 12.74 LE, respectively ; p < 0.001).

SSI tended to be higher among those who had longer time for antibiotic and incision (P30 min) than those who had shorter time interval (< 30 min), (13 % vs.

6.5 %, respectively).

Conclusion : Both penicillin +gentamicin and clindamycin + amikacin are safe and effective for the prevention of SSI in clean contaminated operative procedures.

In a resource limited hospital, a regimen including penicillin +gentamicin is a cost-effective alternative for the more expensive and broader coverage of clindamycin + amikacin.

Timing of PA is effective in preventing SSIs when administered 30 min before the start of surgery.