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Article
Are prophylactic antibiotics justified in pediatric patients with inguinal hernia repair?

Author: Ali E. Joda
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2016 Volume: 15 Issue: 2 Pages: 24-29
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: There are different studies highlighting the role of using prophylactic antibiotics in clean surgeries, but still there is conflicting evidence regarding whether prophylactic antibiotics are beneficial or not in preventing post-operative surgical site infection. Aim: This study aims to evaluate the use of peri-operative prophylactic antibiotics in preventing or reducing surgical site infection in the elective open repair of pediatric inguinal hernia. Patients and method: Over a ten-month period a total 150 pediatric patients underwent elective surgical repair for inguinal hernia were enrolled in this randomized prospective study, they were categorized into two equal Groups alternating at the time of operation. The patients in group A (Control) were followed a standard regimen of giving pre-operative parenteral antibiotic (in the ward or at the beginning of anesthesia) & then post-operative oral antibiotics for five days duration, while the patients in group B (Case) underwent the same surgery, but neither preoperative nor post-operative antibiotics were given. A written informed consent from the parents or child guardian was obtained after explanation. The rate of surgical site infection was compared between the two groups. A p value of less than 0.05 was considered to be significant statistically. Results: The total infection rate in both (case and control groups) was 3.33%, the rate of postoperative wound infection in "case group" was 4 % compared to that in "control group" which was 2.67 %. This noticed variance was statistically insignificant (P value by Chi-Square Test = 0.9883, Two –tailed p value using paired samples- t test was = 0.6578). 80% of the infections were mild (grade 1 & 2) & 60% was noticed in the 3rd post-operative day. Conclusion: This study pointed out that peri-operative prophylactic antibiotics are not justified routinely in pediatric inguinal herniotomy as there is no significant increased risk of postoperative wound infection in "group B" compared to "group A" (p value = 0.6578 using paired samples t- test), & this low risk of wound infection does not warrant the economic burden of their usage in such clean surgical operations.


Article
The Use of Single Versus Multiple Doses Cefotaxime as a Prophylactic Antibiotic in Maxillofacial Fractures

Authors: Atalla F Rejab --- Mohmmed K Hassouni
Journal: Al-Rafidain Dental Journal مجلة الرافدين لطب الأسنان ISSN: 18121217 Year: 2012 Volume: 12 Issue: 1 Pages: 96-101
Publisher: Mosul University جامعة الموصل

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Abstract

Aim: The study aims to test the efficacy of using a single dose of cefotaxime antibiotic intravenously compared to the same drug when used for five days in the prevention of surgical site infection follow-ing maxillofacial fracture operations. Materials and Methods: The study group consisted of 78 pa-tients of different social and educational levels who have sustained maxillofacial fractures. All patients were planned to undergo operative procedures under general anesthesia to treat their fractures. Patients were randomized preoperatively into two groups ( Group A and Group B). Each patient in group A received a single dose of cefotaxime sodium (claforan) 40mg/kg body weight given intravenously at the induction of general anesthesia. No further dose of any antibiotic was given subsequently. Each patient in group B received cefotaxime sodium intravenously 20mg/kg twice daily for five days, start-ing the first dose of cefotaxime sodium at the induction of general anesthesia. During hospitalization postoperatively, patients were examined for signs and symptoms of surgical site infection. After dis-charge, the patients were recalled to the clinic for post-operative examination at 1, 2 , 3 and 4 weeks. Results: Only one patient out of 43 patients in the first group showed signs and symptoms of infection which was confirmed by culture and sensitivity test. Two cases of postoperative infection out of 35 patients developed infection in the second group. Conclusions: Using a single dose of cefotaxime was found to be comparable or even better than the use of the same drug for five days as a prophylactic antibiotic.


Article
Prophylactic Versus Extended Antibiotics Regimen in Breast Cancer Surgery
الوقائي مقابل نظام المضادات الحيوية الممتد ما بعد جراحه سرطان الثدي

Authors: Mazin A Shakir د. مازن صاحب شاكر --- Husam H Ali د.حسام حميد على
Journal: Diyala Journal of Medicine مجلة ديالى الطبية ISSN: 97642219 Year: 2016 Volume: 11 Issue: 1 Pages: 70-78
Publisher: Diyala University جامعة ديالى

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Abstract

Background: A single intravenous preoperative prophylactic dose of an antibiotic with antistaphylococcal activity represent standard care for breast and axillary surgical procedures. Some surgeons also prescribe postoperative extended regimen for all patients with breast and axillary surgery to prevent infection.Objective: To evaluate the efficacy of using post-operative antibiotic (extended regimen)in breast cancer surgery to decrease surgical-site infections.Patients and Methods: One hundred and five females suffering from breast cancer were enrolled in this study (from the 1st of January 2014 to the 30th of December 2015 inAl-Yarmouk Teaching Hospital admitted by multiple surgeons).They was divided into two groups. Group )1( received single prophylactic dose of ceftriaxone injection 1gm preoperatively and group )2( received extended doses postoperatively1 gram twice daily for 4days,then antibiotic changed to oral oute (cefixime 400 mg once daily for 7days). The patients in both groups discharged home in the2nd post-operative day and seen again after five days, then on the days, then on the day of removal of surgicalstitches (day10) and at day30.Allpatientshadclosedsuctionsurgicaldrainswhendischargedfromhospitalandremoved inday5. Second generation cephalosporin was not used because it is not available.Results: During the period of this study, the incidence of wound infection was 7 (15%) in group1 and 6 (10%) in group2. The p value of the incidence of wound infection in these groups was 0.55, so it is statistically not significant.Conclusion: No statistically significant reduction in surgical wound infection among those received postoperative extended doses of antibiotic prophylaxis (i.e.group2) compared with those who received preoperative single dose of antibiotic prophylaxis (i.e.group1) .

خلفية الدراسة: الحقن قبل الجراحة الاتقائية جرعة واحدة من مضاد حيوي مع النشاط أنتيستافيلوكوكال تمثل الرعاية القياسية للثدي والابطيه العمليات الجراحية. يصف بعض الجراحين أيضا نظام المضادات الحيويه الممتد ما بعد العملية الجراحية لجميع مرضى سرطان الثدي وجراحة الابط للوقاية من العدوى. الهدف من الدراسة: لتقييم فعالية استخدام المضادات الحيوية بعد العمليات الجراحية (نظام الممتد) في جراحة سرطان الثدي لتقليل الإصابات موقع الجراحية.المرضى والطرائق : مائة وخمسة من الإناث اللاتيتعانين من سرطان الثدي انتظمن في هذه الدراسة (من الأول من كانون الثاني عام 2014 إلى الثلاثين من كانون الأول عام 2015) في "مستشفى" اليرموك لعدد من الجراحين في ردهة الجراحه العامه). وقد قسموا إلى مجموعتين. المجموعه الاولى تلقي الفريق جرعة وقائية من حقن سيفترياكسون 1 غرام والمجموعة الثانيه تلقي الفريق جرعات ممتده ما بعد الجراحه مرتين يوميا عن طريق الحقن لمدة أربعة أيام، ثم بعدها تغيير المسار عن طريق الفم (cefixime400mg مرة واحدة يوميا لمدة 7 أيام). المرضى في كلتا المجموعتين غادرن الى المنزل في اليوم الثاني بعد العمليه وتم متابعتهن مرة أخرى بعد خمسة أيام، ثم في يوم إزالة الغرز الجراحية (يوم 10)، وفي يوم 30. جميع المرضى قد أغلق التصريف الجراحي للشفط عندما خرجن من المستشفى وتم إزالته في يوم 5. عقار سيفالوسبورين الجيل الثاني لم يستخدم نظراً لأنه غير متوفروقت اجراء البحث.النتائج: خلال فترة هذه الدراسة، كان حدوث عدوى الجرح 7 (15 في المائة) في المجموعة الاولى و 6 (10 ٪) في المجموعه الثانيه وكانت الفروقات في الإصابة بعدوى الجرح في هذه المجموعات غير معنويه إحصائيا. الاستنتاجات: لا يوجد فرق معتد به إحصائيا في عدوى الجرح الجراحي بين أولئك اللاتي تلقين جرعات ممتده بعد العملية الجراحية للاتقاء بالمضادات الحيوية (ألمجموعه الثانيه) مقارنة مع أولئك الذين تلقوا جرعة واحدة ماقبل الجراحة للاتقاء بالمضادات الحيوية (المجموعة الاولى).

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