Skip to main content
SpringerLink
Log in

Prophylactic antibiotics for patients undergoing elective biliary tract surgery: A prospective randomized study of cefotiam and cefoperazone

  • Original Articles
  • Published:
The Japanese journal of surgery Aims and scope Submit manuscript

Abstract

Cefotiam, a second generation cephalosporin and cefoperazone, a third generation cephalosporin have a broad spectrum of activity against a majority of organisms commonly found in the bile. Although cefoperazone is excreted into the human bile to a greater extent than is cefotiam, there are no comparative data available that cefoperazone prophylaxis is safer and more effective than cefotiam for patients undergoing biliary tract surgery. A prospective randomized study was performed to compare the safety and efficacy of cefotiam with those of cefoperazone for prophylaxis in patients undergoing elective biliary tract surgery. The incidence of postoperative infection was not significantly different between the cefotiam group (n=86) and the cefoperazone group (n=86). The rate of side effects, however, was significantly different. In the cefotiam group, only one patient had diarrhea whereas in the cefoperazone group, eight had diarrhea and one skin eruption.Clostridium difficile cytotoxin was nil in those with diarrhea. Diarrhea in all patients was mild and recovery was rapid. Cefotiam is thus safer and as effective as cefoperazone in preventing postoperative infections following biliary tract surgery. We suggest that cefotiam is the first choice antibiotic for prophylaxis in biliary tract surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Stone HH, Hooper CA, Kolb LD, Geheber CE, Dawkins EJ. Antibiotic prophylaxis in gastric, biliary and colonic surgery. Ann Surg 1976; 184: 443–452.

    PubMed  CAS  Google Scholar 

  2. Kaufman Z, Engelberg M, Eliashiv A, Reiss R. Systemic prophylactic antibiotics in elective biliary surgery Arch Surg 1984; 119: 1002–1004.

    PubMed  CAS  Google Scholar 

  3. Keighley MRB, Baddeley RM, Burdon DW, Edwards JAC, Quoraishi AH, Oates GD, Watts GT, Alexander-Williams J. A controlled trial of parenteral prophylactic gentamicin therapy in biliary surgery. Br J Surg 1975; 62: 275–279.

    PubMed  CAS  Google Scholar 

  4. Morran C, McNaught W, McArdle CS. Prophylactic cotrimoxazole in biliary surgery. Br Med J 1978; 2: 462–464.

    PubMed  CAS  Google Scholar 

  5. Strachan CJL, Black J, Powis SJA, Waterworth TA, Wise R, Wilkinson AR, Burdon DW, Severn M, Mitra B, Norcott H. Prophylactic use of cephazolin against wound sepsis after cholecystectomy. Br Med J 1977; 1: 1254–1256.

    PubMed  CAS  Google Scholar 

  6. Cainzos M, Potel J, Puente JL. Prospective randomized controlled study of prophylaxis with cefamandole in high risk patients undergoing operations upon the biliary tract. Surg Gynecol Obstet 1985; 160: 27–32.

    PubMed  CAS  Google Scholar 

  7. Gunn AA. Antibiotics in biliary surgery. Br J Surg 1976; 63: 627–630.

    PubMed  CAS  Google Scholar 

  8. Wolloch Y, Feigenberg Z, Zer M, Dintsman M. The influence of biliary infection on the postoperative course after biliary tract surgery. Am J Gastroenterol 1977; 67: 456–462.

    PubMed  CAS  Google Scholar 

  9. Shinagawa N, Suzuki I, Suzuki Y, Doi T, Hanai T, Hayakawa Y, Ishikawa S, Takaoka T, Okumura K, Iwai A, Kato F, Yura J. Clinical significance of bacterial flora in biliary tract disease. Jpn J Gastroenterol Surg 1983; 16: 543–546.

    Google Scholar 

  10. Flemma RJ, Flint LM, Osterhout S, Shinleton WW. Bacteriologic studies of biliary tract infection. Ann Surg 1976; 166: 563–572.

    Article  Google Scholar 

  11. Robson MC, Bogart JN, Heggers JP. An endogenous source for wound infection based on quantitative bacteriology of the biliary tract. Surgery 1970; 68: 471–476.

    PubMed  CAS  Google Scholar 

  12. Chetlin SH, Elliot DW. Preoperative antibiotics in biliary surgery. Arch Surg 1973; 107: 319–323.

    PubMed  CAS  Google Scholar 

  13. Cox JL, Helfrich LR, Pass HI, Osterhaut S, Shingleton WW. The relationship between biliary tract infections and postoperative complications. Surg Gynecol Obstet 1978; 146: 233–236.

    PubMed  CAS  Google Scholar 

  14. Chetlin SH, Elliott DW, Biliary bacteremia. Arch Surg 1971; 102: 203–207.

    Google Scholar 

  15. Keighley MRB, Flinn R, Alexander-Williams J. Multivariate analysis of clinical and operative findings associated with biliary sepsis. Br J Surg 1976; 63: 528–531.

    PubMed  CAS  Google Scholar 

  16. Crenshow CA, Glanges E, Webber CE, McReynolds DB. A prospective, randomized, double blind study of preventive cefamendole therapy in patients at high risk for undergoing cholecystectomy. Surg Gynecol Obstet 1981; 153: 546–550.

    Google Scholar 

  17. Kellum JM, Gargano S, Gorbach SL, Talcof C, Curtis LE, Weiner B, McCoobery M, Tan JS, Kelly T, Wagner D, Starks M, File TM, Gills S. Antibiotic prophylaxis in high-risk biliary operations: Multicenter trial of single preoperative ceftriaxone versus multidose cefazolin. Am J Surg 1984; 19: 15–18.

    Google Scholar 

  18. Morran CG, Thomson G, White A, McNaught W, Smith DC, McArdle CS. Wound sepsis after low risk elective cholecystectomy: the effect of cefroxime. Br J Surg 1984; 71: 540–542.

    PubMed  CAS  Google Scholar 

  19. Satake K, Cho K, Taniura M, Oka I, Koo I. Cefotiam concentrations in bile and in the wall of the gallbladder in patients with biliary disease. J Antimicrob Chemother 1982; 10: 141–145.

    PubMed  CAS  Google Scholar 

  20. Nakamura R, Hashimoto I, Sawada Y, Mikami J, Bekki E, Hirasawa S, Abe H, Watanabe Y. Cefoperazone concentrations in bile and gallbladder wall after intravenous administration. Antimicrob Agents Chemother 1980; 18: 980–982.

    PubMed  CAS  Google Scholar 

  21. Satake K, Cho K, Taniura M, Oka I, Koo I. Cefotiam concentration in bile and in the wall of the gallbladder in patients with biliary disease. J Antimicrob Chemother 1984; 10: 141–145.

    Google Scholar 

  22. Kemmerich B, Lode H, Borner K, Belmega D, Jendroschek T, Koepper P, Goertz G. Biliary excretion and pharmacokinetics of cefoperazone humans. J Antimicrob Chemother 1983; 12: 27–37.

    PubMed  CAS  Google Scholar 

  23. Stone HH, Haney BB, Kolb LD, Geheber CE, Hooper CA. Prophylactic and preventive antibiotic therapy. Timing, duration and economics. Ann Surg 1979; 189: 691–699.

    PubMed  CAS  Google Scholar 

  24. Tanner WA, Ali AE, Collins PG, Fahy AM, Lane BE, McCormack T. Single dose intra-rectal metronidazole as prophylaxis against wound infection following emergency appendicetomy. Br J Surg 1980; 67: 809–810.

    PubMed  CAS  Google Scholar 

  25. Higgins AF, Lewis A, Noone P, Hole ML. Single and multiple dose cotrimoxazole and metronidazole in colorectal surgery. Br J Surg 1980; 67: 90–92.

    PubMed  CAS  Google Scholar 

  26. Hares MM, Hegarty MA, Warlow J, Malins D, Youngs D, Bentley S, Burdon DW, Keighley MRB. A controlled trial to compare systemic and intraincisional cefuroxime prophylaxis in high risk gastric surgery. Br J Surg 1981; 68: 276–280.

    PubMed  CAS  Google Scholar 

  27. Wilson NIL, Wright PA, McArdle CS. Survey of antibiotic prophylaxis in gastrointestinal surgery in Scotland. Br Med J 2502; 285: 871–873.

    Article  Google Scholar 

  28. Filkins JP, Luzio NR. Effect of heparin and sulfated polysaccharides onin vitro hepatic phagocytosis. Proc Soc Exp Biol Med 1966; 122: 548–551.

    PubMed  CAS  Google Scholar 

  29. Kaplan JE, Saba TM. Enhancement of reticuloendothelial activity by low dose heparin during intravascular coagulation. J Reticuloendothel Soc 1981; 29: 381–393.

    PubMed  CAS  Google Scholar 

  30. Doran JE, Mansberger AR, Edmondoson HT, Reese AC. Cold insoluble globulin and heparin interactions in phagocytosis by macrophage monolayers: Mechanism of heparin enhancement. J Reticuloendothel Soc 1981; 29: 285–294.

    PubMed  CAS  Google Scholar 

  31. Saba TM, Antikatzides TG. Heparin induced alterations in clearance and distribution of blood-bone microparticles following operative trauma. Ann Surg 1979; 189: 426–432.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The First Department of Surgery, Nagoya City University Medical School, 1, Kawasumi, Mizuho, 467, Nagoya, Japan

    Nagao Shinagawa MD, Yoshimasa Tachi, Shu Ishikawa & Jiro Yura

Authors
  1. Nagao Shinagawa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshimasa Tachi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shu Ishikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jiro Yura
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shinagawa, N., Tachi, Y., Ishikawa, S. et al. Prophylactic antibiotics for patients undergoing elective biliary tract surgery: A prospective randomized study of cefotiam and cefoperazone. The Japanese Journal of Surgery 17, 1–8 (1987). https://doi.org/10.1007/BF02470577

Download citation

  • Received:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02470577

Key words

Search

Navigation