Single dose versus multiple dose antibiotics in laparoscopic cholecystectomy: A prospective comparative single blind study
Introduction: There is a controversy on single dose or multiple doses of prophylactic antibiotics for prevention of surgical site infection during laparoscopic cholecystectomy in a developing country setting. The objective of this study was to compare single versus multiple doses of prophylactic antibiotics in terms of surgical site infection in laparoscopic cholecystectomy patients.
Methods: This was a prospective, comparative, randomized study was conducted in a medical college hospital. Two hundred consecutive patients with symptomatic cholelithiasis planned for routine laparoscopic cholecystectomy were enrolled in the study. Patients were randomly divided in a Single dose (SD) group and multiple dose (MD) group. SD group were given injection ceftriaxone (1gm) before induction of anesthesia and MD group received ceftriaxone (1gm) before induction of anesthesia and continued a total of 3 doses postoperatively for next 24 hours.
Results: A total of 200 patients were studied, of which 100 were in single dose (SD group) and another 100 in multiple dose (MD group). The mean age of patients with symptomatic cholelithiasis was 41.76 ± 13.38 years with minimum of 16 years and maximum of 73 years. Of the total patients, 4 patients in single dose (SD) group and 3 patients in multiple dose (MD) group developed surgical site infection of various severity which was not statistically significant. (p=0.500).
Conclusion: There is no difference in terms of surgical site infection in patients taking either single or multiple doses of antibiotics in laparoscopic cholecystectomy in a medical college setting in Nepal.
Bittner R. Laparoscopic Surgery-15 years after clinical introduction, World Journal of Surgery 30:7(2006)1190-203.
Zhou H Zhang j, Wang Q, Hu Z .Meta-analysis: antibiotic prophylaxis in elective laparoscopic cholecystectomy. Alimentary Pharmacology and Therapeutics 2009;29(10):1086-95. https://doi.org/10.1111/j.1365-2036.2009.03977.x PMid:19236313
Sanabria A, Dominguez LC, Valdivieso E ,Gomez G. Antibiotic prophylaxis for patients undergoing elective laparoscopic cholecystectomy .Cochrane Database of Systematic Reviews 2010;12;CD005265. https://doi.org/10.1002/14651858.CD005265.pub2
Chang WT, Lee KT, Chuang SC, Wang SN, Kuo KK, Chen JS, et al. The impact of prophylactic antibiotics on postoperative infection complication in elective laparoscopic cholecystectomy: a prospective randomized study. Am J Surg 2006;191(6):721-5. https://doi.org/10.1016/j.amjsurg.2006.01.050 PMid:16720138
Sutariya PK, Thekdi PI. Single dose versus multiple dose prophylactic antibiotic in laparoscopic cholecystectomy: a comparative study. Int Surg J 2016; 3: 633-6 https://doi.org/10.18203/2349-2902.isj20161135
Lippert H.Gastingerj. Antimicrobial prophylaxis in laparoscopic and conventional cholecystectomy .Conclusions of a large prospective multicenter quality assurance study in Germany Chemotherapy.1998;44:355-63.
Clarke JS, Condon RE, Bartlett JG, Gorbach SL, Nichols RL, Ochi S, Preoperative oral antibiotics reduce septic complications of colon operations results of prospective, randomized, double-blind clinical study. Ann Surg 1977;186(3):251-9. https://doi.org/10.1097/00000658-197709000-00003
Malik SA, Yaseen MA, Nasreen G. Single and simple antibiotic prophylaxis for elective cholecystectomy. J Coll physicians Surg Pak 2009;19(3):154-7. PMid:19268013
Higgins A, London J, Charland S, Ratzer E, Clark J, Haun W, et al. Prophylactic antibiotics for elective laparoscopic cholecystectomy: are they necessary?Arch Surg 1999;134(6):611-3. https://doi.org/10.1001/archsurg.134.6.611 PMid:10367869
Abro AH, Pathan AH, Siddiqui FG, Syed F, Laghari AA. Single dose versus 24 hours antibiotic prophylaxis against surgical site infections. JLUMHS 2014; 13(1): 27-31.
Koirala A, Thakur D, Agrawal S, Pathak KR, Bhattarai M, Sharma A. Laparoscopic cholecystectomy, A single surgeon experience at Teaching Hospital Biratnagar, Nepal. Journal of Nobel Medical College 2017;6(10):1-5.
Shrestha S ,Pradhan G, Bhoomi K, Dhital A, Bhattachan CL. Review of laparoscopic cholecystectomy in Nepal Medical College Journal 2007;9:1.
Eshy SA, Mahfauz AA, Badr A, Gamal MN, Shehri MY, Salati MI,et al. Prevalence ad risk factors of gall stone disease in a high altitude Saudi population. La Revue de Sante' de la Mediterrance orientale 2007;13(4):794-802.
Gaur SA, Pujahari AK. Role of prophylactic antibiotics in laparoscopic cholecystectomy. MJAFI 2010:66:228-30. https://doi.org/10.1016/S0377-1237(10)80043-7
Koc M, Zulfikaroglu B, Kece C, Ozalp N. A prospective randomized study of prophylactic antibiotics in elective laparoscopic cholecystectomy. Surg Endosc 2003;17:1716-18. https://doi.org/10.1007/s00464-002-8866-y PMid:12802644
Meijer WS, Schmitz PIM, Jeekel J. Meta analysis of randomized, controlled clinical trials of antibiotic prophylaxis in biliary tract surgery. BRJ Surg 1990;77(3):283-90. https://doi.org/10.1002/bjs.1800770315
Waldvogel FA, Vaudaux PE, Pittet D, Lew PD. Perioperative antibiotic prophylaxis of wound and foreign body infections: microbial factors affecting efficacy. Rev infect Dis1991;13(10):782-9. https://doi.org/10.1093/clinids/13.Supplement_10.S782
Copyright (c) 2019 Ashok Koirala, Dipendra Thakur, Sunit Agrawal, Bhuwan Lal Chaudhary
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC BY-4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.