Skip to main content
SpringerLink
Log in

Ceftriaxone versus Other Antibiotics for Surgical Prophylaxis

A Meta-Analysis

  • Original Research Article
  • Published:
Clinical Drug Investigation Aims and scope Submit manuscript

Abstract

Objective

To investigate possible differences in prophylaxis with ceftriaxone compared with other antimicrobial agents for surgical-site infections and remote infections such as respiratory tract infections (RTIs) and urinary tract infections (UTIs).

Methods

The efficacy of ceftriaxone was compared with that of other antibiotics in the perioperative prophylaxis of local (surgical wound) and remote (RTIs and UTIs) infections in a meta-analysis of randomised controlled trials published between 1984 and 2003. The analysis was based on a 2 × 2 contingency table with classification by treatment and number of infections obtained from individual studies.

Results

Evaluations were performed on 48 studies, for a total of 17 565 patients. Overall, 406 patients (4.8%) in the ceftriaxone group and 525 (6.3%) in the comparator group developed a surgical-site infection (log odds ratio [OR] −0.30 [CI −0.50 to −0.13]; p < 0.0001). RTIs were observed in 292 (6.01%) patients in the ceftriaxone group and in 369 (7.6%) patients in the comparator group, (log OR −0.30 [CI −0.55 to −0.09]; p = 0.0013). UTIs were reported for 2.2% of the ceftriaxone prophylaxis patients compared with 3.74% of the comparator group patients (log OR −0.54 [CI −1.18 to −0.16]; p < 0.0001). Overall, in clean surgery 195 (5.1%) and 234 (6.2%) patients developed a surgical site infection in the ceftriaxone and comparator groups, respectively (log OR −0.22 [CI −0.51 to 0.01]; p = 0.0476). RTIs were prevented for all but 1.57% of patients in the ceftriaxone group and 2.62% of patients in the comparator group (p = 0.01) in clean surgery, and for 9.54% of the ceftriaxone group versus 11.6% of the comparator group (p = 0.01) in clean-contaminated surgery. While results observed in clean surgery did not show statistically significant superiority of ceftriaxone in preventing UTI insurgence (log OR −0.21 [CI 0.0–0.65]; p = 0.7702), this was clearly shown in the clean-contaminated surgery. In fact, 4.47% of patients in the ceftriaxone group versus 7.52% of patients in the comparator group developed a UTI (log OR −0.56 [CI −1.25 to −0.16]; p < 0.0001). Adverse events were observed in a similar proportion in the ceftriaxone prophylaxis and the comparator groups (0.35% and 0.23%, respectively). Duration of prophylaxis did not influence outcome of infection.

Conclusions

The meta-analysis showed that ceftriaxone is statistically superior to other antibiotics in preventing both local and remote postoperative infections.

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

Table I
Table II
Table III
Table IV
Table V

Similar content being viewed by others

References

  1. Smyth ETM, Emmerson AM. Surgical site infection surveillance. J Hosp Infect 2000; 45: 173–84

    Article  PubMed  CAS  Google Scholar 

  2. Mangram AJ, Horan TC, Pearson ML, et al. Guideline for prevention of surgical site infection, 1999: Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999; 20: 247–78

    Article  Google Scholar 

  3. Martone WJ, Jarvis WR, Culver DH, et al. Incidence and nature of endemic and epidemic nosocomial infections. In: Bennett JV, Brachman PS, editors. Hospital infections. Boston (MA): Little, Brown, and Company, 1992: 577–596

    Google Scholar 

  4. Classen DC, Evans RS, Pestotnik SL, et al. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992; 326: 281–6

    Article  PubMed  CAS  Google Scholar 

  5. Wise R. Beta-lactams: cephalosporins. In: O’Grady F, Lambert PH, Finch RG, et al., editors. Antibiotics and chemotherapy. 7th ed. New York: Churchill Livingstone 1997: 202–55

    Google Scholar 

  6. Esposito S, Novelli A, de Lalla F. Antibiotic prophylaxis in surgery: news and controversies. Infez Med 2002; 3: 131–44

    Google Scholar 

  7. L’Abbé KA, Detsky AS, O’Rourke K. Meta-analysis in clinical research. Ann Intern Med 1987; 107: 224–33

    PubMed  Google Scholar 

  8. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996; 17: 1–12

    Article  PubMed  CAS  Google Scholar 

  9. Garner JS, Emori TG, Horan TC, et al. CDC definitions for nosocomial infections. In: Olmsted RN, editor. APIC infection control and applied epidemiology: principles and practice. St Louis (MO): Mosby, 1996: A1–A20

    Google Scholar 

  10. B’Erard F, Gandon J. Postoperative wound infections: the influence of ultraviolet irradiation of the operating room and various other factors. Ann Surg 1964; 160 Suppl. 1: 1–19

    Google Scholar 

  11. Beam TR, Raab TA, Spooner JA, et al. Comparison of ceftriax-one and cefazolin prophylaxis against infection in open heart surgery. Am J Surg 1984; 148(4A): 8–14

    PubMed  CAS  Google Scholar 

  12. Periti P, Mazzei T, Lamanna S, et al. Single-dose ceftriaxone versus multi-dose cefotaxime antimicrobial prophylaxis in gynecologic and obstetrical surgery: preliminary results of a multicenter prospective randomized study. Chemioterapia 1984; 3(5): 299–302

    PubMed  CAS  Google Scholar 

  13. Kellum JM, Gargano S, Gorbach SL, et al. Antibiotic prophylaxis in high-risk biliary operations: multicenter trial of single preoperative ceftriaxone versus multidose cefazolin. Am J Surg 1984; 148(4A): 15–8

    PubMed  Google Scholar 

  14. Beam TR, Raab T, Spooner J, et al. Single-dose antimicrobial prophylaxis in open heart surgery. Eur J Clin Microbiol 1984; 3(6): 598–604

    Article  PubMed  CAS  Google Scholar 

  15. Hemsell DL, Johnson ER, Bawdon RE, et al. Ceftriaxone and cefazolin in prophylaxis for hysterectomy. Surg Gynecol Obstet 1985; 161(3): 197–203

    PubMed  CAS  Google Scholar 

  16. Geroulanos S, Donfried B, Schumacher F, et al. Cefuroxime versus ceftriaxone prophylaxis in cardiovascular surgery. Drugs Exp Clin Res 1985; 11(3): 201–5

    PubMed  CAS  Google Scholar 

  17. Wohlfahrt R, Siedek M. Perioperative infection prophylaxis in colon surgery. Chemioterapia 1987; 6 Suppl. 2: 603–4

    PubMed  CAS  Google Scholar 

  18. Recker F, Geroulanos S, Turina M. Perioperative antibiotic prophylaxis in heart and vascular surgery: a prospective randomized comparative study with cefazolin and ceftriaxone. Dtsch Med Wochenschr 1987; 112(4): 135–8

    Article  PubMed  CAS  Google Scholar 

  19. Harms E, Schumacher C. Effectiveness of perioperative prophylaxis with ceftriaxone and cefotaxime in vaginal hysterectomy with and without anterior and/or posterior colporrhaphy. Chemioterapia 1987; 6 Suppl. 2: 622–3

    PubMed  CAS  Google Scholar 

  20. Lang SDR, Morris AJ, Charlesworth PM. Prophylaxis in appendicectomy with cefoxitin or ceftriaxone. N Z Med J 1988; 101(858): 781–3

    PubMed  CAS  Google Scholar 

  21. Tristaino B, Talpacci A, Fabbri C, et al. Short-term antimicrobial chemoprophylaxis in surgery at high risk for infectious complications: ceftriaxone versus cefoxitin. Minerva Chir 1988; 43(3): 157–62

    PubMed  CAS  Google Scholar 

  22. Battarino O, Battarino A. Short-term antibiotic prophylaxis in cesarean section. Minerva Ginecol 1988; 40(9): 563–7

    PubMed  CAS  Google Scholar 

  23. Badel P, Schmuziger M. Anti-infection prophylaxis in cardiac surgery: comparison of single-dose ceftriaxone and cefa-mandole in repeat doses. Schweiz Rundsch Med Praxis 1989; 78(22): 643–5

    CAS  Google Scholar 

  24. Soteriou M, Recker F, Geroulanos S, et al. Perioperative antibiotic prophylaxis in cardiovascular surgery. World J Surg 1989; 13: 798–802

    Article  PubMed  CAS  Google Scholar 

  25. Thorsteinsson SB, Einarsson GV, Steingrimsson O, et al. Antibiotic prophylaxis in transurethral surgery. Scand J Infect Dis Suppl 1990; 70: 68–73

    PubMed  CAS  Google Scholar 

  26. Stiver HG, Binns BO, Brunham RC, et al. Randomized, double-blind comparison of the efficacies, costs, and vaginal flora alterations with single-dose ceftriaxone and multidose cefazolin prophylaxis in vaginal hysterectomy. Antimicrob Agents Chemother 1990; 34(6): 1194–7

    Article  PubMed  CAS  Google Scholar 

  27. Karachalios TH, Lyritis GP, Hatzopoulos E. Antibiotic prophylaxis in the surgical treatment of peritrochanteric fractures: a comparative trial between two cephalosporins. Chemotherapy 1990; 36: 448–53

    Article  PubMed  CAS  Google Scholar 

  28. Neidhart P, Velebit V, Gunning K, et al. A comparative study of cefamandole and ceftriaxone as prophylaxis in cardiac surgery. Infection 1990; 18(2): 101–4

    Article  PubMed  CAS  Google Scholar 

  29. Hall JC, Hall JL. A comparison of the roles of cefamandole and ceftriaxone in abdominal surgery. Arch Surg 1991; 126: 512–6

    Article  PubMed  CAS  Google Scholar 

  30. Tsimoyiannis EC, Paizis JB, Kabbani K, et al. Short-time antibiotic prophylaxis in elective colorectal surgery. Chemo-therapy 1991; 91(37): 66–9

    Google Scholar 

  31. Luke M, Iversen J, Søndergaard J, et al. Ceftriaxone vs ampicillin + metronidazole as prophylaxis against infections after clean-contaminated abdominal surgery. Eur J Surg 1991; 157: 45–9

    PubMed  CAS  Google Scholar 

  32. Hjortrup A, Moesgaard F, Jensen F, et al. Antibiotic prophylaxis in high risk biliary surgery: one dose of ceftriaxone compared with two doses of cefuroxime. Eur J Surg 1991; 157: 403–5

    PubMed  CAS  Google Scholar 

  33. Tauzin-Fin P, Ragnaud JM, Houdek MC, et al. Flash antibiotic prophylaxis in endoscopic resections of the prostate: cefamandole versus ceftriaxone. Cah Anesthesiol 1991; 39(1): 29–33

    PubMed  CAS  Google Scholar 

  34. Demetriades D, Lakhoo M, Pezikis A, et al. Short-course antibiotic prophylaxis in penetrating abdominal injuries: ceftriaxone versus cefoxitin. Injury 1991; 22(1): 20–4

    Article  PubMed  CAS  Google Scholar 

  35. Rotman N, Flamant Y, Hay JM, et al. Antibiotic prophylaxis in abdominal surgery: prospective randomized study organized by the French Surgical Research Association. Presse Med 1991; 20(34): 1659–63

    PubMed  CAS  Google Scholar 

  36. Lumley JW, Siu SK, Pillay SP, et al. Single dose ceftriaxone as prophylaxis for sepsis in colorectal surgery. Aust N Z J Surg 1992; 62: 292–6

    Article  PubMed  CAS  Google Scholar 

  37. Fingerhut A, Hay JM, the French Association for Surgical Research. Single-dose ceftriaxone, ornidazole, and povidoneiodine enema in elective left colectomy. Arch Surg} 1993}; 128}: 228–32

    Article  PubMed  CAS  Google Scholar 

  38. Hall JC, Christiansen K, Carte MJ, et al. Antibiotic prophylaxis in cardiac operations. Ann Thorac Surg 1993; 56(4): 916–22

    Article  PubMed  CAS  Google Scholar 

  39. Matikainen M, Hiltunen KM. Parenteral single dose ceftriaxone with tinidazole versus aminoglycoside with tinidazole in colorectal surgery: a prospective single-blind randomized multi-centre study. Int J Colorectal Dis 1993; 8: 148–50

    Article  PubMed  CAS  Google Scholar 

  40. Morris WT. Ceftriaxone is more effective than gentamicin/ metronidazole prophylaxis in reducing wound and urinary tract infections after bowel operations. Dis Colon Rectum 1993; 36(9): 826–33

    Article  PubMed  CAS  Google Scholar 

  41. Schweizer W, Striffeler H, Liidi D, et al. Single shot prevention in abdominal surgery: antibiotics with long half-life (ceftriaxone, ornidazole) vs antibiotics with a short half-life (cefazolin, metronidazole, clindamycin). Helv Chir Acta 1993; 60: 483–8

    Google Scholar 

  42. Morris WT. Effectiveness of ceftriaxone versus cefoxitin in reducing chest and wound infections after upper abdominal operations. Am J Surg 1994; 167: 391–5

    Article  PubMed  CAS  Google Scholar 

  43. Sisto T, Laurikka J, Tarkka MR. Ceftriaxone vs cefuroxime for infection prophylaxis in coronary bypass surgery. Scand J Thorac Cardiovasc Surg 1994; 28: 143–8

    Article  PubMed  CAS  Google Scholar 

  44. Hotz G, Novotny-Lenhard J, Kinzig M, et al. Single-dose antibiotic prophylaxis in maxillofacial surgery. Chemotherapy 1994; 40: 65–9

    Article  PubMed  CAS  Google Scholar 

  45. Brouwer WK, Hoogkamp Korstanje AA. Single-dose ceftriaxone versus single-dose cefuroxime plus metronidazole for preventing febrile morbidity and urinary tract infection in vaginal hysterectomy. Eur J Obstet Gynecol Reprod Biol 1991; 2: 143–6

    Google Scholar 

  46. Anderson GRN, Boldiston C, Woods S, et al. A cost-effectiveness evaluation of 3 antimicrobial regimens for the prevention of infective complications after abdominal surgery. Arch Surg 1996; 131(7): 744–8

    Article  PubMed  CAS  Google Scholar 

  47. Heit JM, Stevens M, Jeffords K. Comparison of ceftriaxone with penicillin for antibiotic prophylaxis for compound mandible fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997; 83(4): 423–6

    Article  PubMed  CAS  Google Scholar 

  48. Ilic N, Petricevic A, Kotarac S, et al. Single-dose ceftriaxone versus multiple-dose cefuroxime for antimicrobial chemopro-phylaxis in pleuropulmonary surgery. Panminerva Med 1997; 39: 240–3

    PubMed  CAS  Google Scholar 

  49. Ross CB, Wheeler WG, Jones MJ, et al. Ceftriaxone versus cefazolin in peripheral arterial operations: a randomized, prospective trial. South Med J 1997; 90(1): 16–22

    Article  PubMed  CAS  Google Scholar 

  50. Thomas R, Alvino P, Cortino GR, et al. Long-acting versus short-acting cephalosporins for preoperative prophylaxis in breast surgery: a randomised double-blind trial involving 1766 patients. Chemotherapy 1999; 45: 217–23

    Article  PubMed  CAS  Google Scholar 

  51. Kriaras I, Michalopoulos A, Turina M, et al. Evolution of antimicrobial prophylaxis in cardiovascular surgery. Eur J Cardiothorac Surg 2000; 18: 440–6

    Article  PubMed  CAS  Google Scholar 

  52. Zhu XL, Wong WK, Yeung WM, et al. A randomized double-blind comparison of ampicillin/sulbactam and ceftriaxone in the prevention of surgical-site infections after neurosurgery. Clin Ther 2001; 23(8): 1281–91

    Article  PubMed  CAS  Google Scholar 

  53. Woodfield JC, Van Rij AM, Pettigrew RA, et al. A comparison of the prophylactic efficacy of ceftriaxone and cefotaxime in abdominal surgery. Am J Surg 2003; 185: 45–9

    Article  PubMed  CAS  Google Scholar 

  54. Horan TC, Gaynes RP, Martone WJ, et al. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992; 13: 606–8

    Article  PubMed  CAS  Google Scholar 

  55. De Lalla F. Antimicrobial prophylaxis in clean surgery. Infez Med 1997; 5(4): 214–29

    PubMed  Google Scholar 

  56. Camporese A, Calianno G. A proposal for guidelines of antimicrobial prophylaxis in surgery and surveillance of their application. Infez Med 2000; 8(3): 139–55

    PubMed  Google Scholar 

  57. Thadepalli H, Mandai AK. Antibiotic prophylaxis in the surgical patient. Infez Med 1998; 6(2): 71–80

    PubMed  Google Scholar 

  58. Burke JF. The effective period of preventive antibiotic in experimental incision and dermal lesion. Surgery 1961; 50: 161–8

    PubMed  CAS  Google Scholar 

  59. Rowe-Jones DC, Peel ALG, Kingstone RD, et al. Single-dose cefotaxime plus metronidazole versus three doses of cefuroxime plus metronidazole as prophylaxis against wound infection in colorectal surgery: multicentre prospective randomized trial. BMJ 1990; 300: 18–22

    Article  PubMed  CAS  Google Scholar 

  60. McDonald M, Grabsch M, Marshall C, et al. Single versus multiple dose antimicrobial prophylaxis for major surgery: a systematic review. Aust N Z J Surg 1998; 68: 388–96

    Article  PubMed  CAS  Google Scholar 

  61. Waddell TK, Rotstein OD. Antimicrobial prophylaxis in surgery: Committee on Antimicrobial Agents, Canadian Infectious Disease Society. CMAJ 1994; 151: 925–31

    PubMed  CAS  Google Scholar 

  62. Warren JW. Urethral catheters and nosocomial urinary tract infections. Infect Control Hosp Epidemiol 1996; 17(4): 212–4

    Article  PubMed  CAS  Google Scholar 

  63. Page CP, Bohnen JM, Fletcher JR, et al. Antimicrobial prophylaxis for surgical wounds: guidelines for critical care. Arch Surg 1993; 128: 79–88

    Article  PubMed  CAS  Google Scholar 

  64. Gudiol F. Surgical antibiotic prophylaxis: tradition and change. Int J Clin Pract 1998; 95 Suppl. 1: 39S–43S

    Google Scholar 

  65. Morris WT. Effectiveness of ceftriaxone versus cefoxitin in reducing chest and wound infections after upper abdominal operations. Am J Surg 1994; 167: 391–5

    Article  PubMed  CAS  Google Scholar 

  66. Dietrich ES, Bieser U, Frank U, et al. Ceftriaxone versus other cephalosporins for perioperative antibiotic prophylaxis: a meta-analysis of 43 randomized controlled trials. Chemotherapy 2002; 48: 49–56

    Article  PubMed  CAS  Google Scholar 

  67. Paradisi F, Corti G. Which prophylaxis regimen for which surgical procedure? Am J Surg 1992; 164 Suppl. 4A: 2S–5S

    Article  PubMed  CAS  Google Scholar 

  68. Pallares R, Pujol M, Pena C, et al. Cephalosporins as risk factor for nosocomial Enterococcus faecalis bacteremia: a matched case-control study. Arch Intern Med 1992 Jul 12; 153: 1581–6

    Article  Google Scholar 

  69. Terpstra S, Noordhoek GT, Voesten HGJ, et al. Rapid emergence of resistant coagulase-negative staphylococci on the skin after antibiotic prophylaxis. J Hosp Infect 1999; 43: 195–202

    Article  PubMed  CAS  Google Scholar 

  70. Edlund C, Stark C, Nord CE. The relationship between an increase in beta-lactamase activity after oral administration of three new cephalosporins and protection against intestinal ecological disturbances. J Antimicrob Chemother 1994; 34: 127–8

    Article  PubMed  CAS  Google Scholar 

  71. Dancer SJ. The problem with cephalosporins. J Antimicrob Chemother 2001; 48: 463–78

    Article  PubMed  CAS  Google Scholar 

  72. Archer GL, Armstrong BO Alteration of staphylococcal flora in cardiac surgery patients receiving antibiotic prophylaxis. J Infect Dis 1983; 147: 642–9

    Article  PubMed  CAS  Google Scholar 

  73. Kernodle DS, Barg NL, Kaiser AB. Low-level colonization in hospitalized patients with methicillin-resistant coagulase-negative staphylococci and emergence of the organisms during surgical antimicrobial prophylaxis. Antimicrob Agents Chemother 1988; 32: 202–8

    Article  PubMed  CAS  Google Scholar 

  74. Jones RN. The current and future impact of antimicrobial resistance among nosocomial pathogens. Diagn Microbiol Infect Dis 1992; 15 Suppl. 2: 3S–10S

    PubMed  CAS  Google Scholar 

  75. Edgeworth JD, Treacher DF, Eykyn SJ. A 25-year study of nosocomial bacteremia in an adult intensive care unit. Crit Care Med 1999; 27(8): 1648–50

    Article  Google Scholar 

  76. Karlowsky JA, Jones ME, Mayfield DC, et al. Ceftriaxone activity against Gram-positive and Gram-negative pathogens isolated in US microbiology laboratories from 1996 to 2000: results from The Surveillance Network Database-USA. Int J Antimicrob Agents 2002; 19: 413–26

    Article  PubMed  CAS  Google Scholar 

  77. Lumley JW, Siu SK, Pillay SP, et al. Single dose ceftriaxone as prophylaxis for sepsis in colorectal surgery. Aust N Z J Surg 1992; 62: 292–6

    Article  PubMed  CAS  Google Scholar 

  78. Le Hunt M, O’Malley V, Reddy P, et al. Effective prophylaxis in biliary surgery using single dose ceftriaxone. Chemioterapia 1984; 167(4 Suppl. 2): 729–30

    Google Scholar 

Download references

Acknowledgements

The authors thank Roche SpA for their support in providing the literature and for the statistical analysis. The authors do not have any potential conflicts of interest that are directly relevant to the content of this manuscript.

Author information

Authors and Affiliations

  1. Dipartimento di Medicina Pubblica Clinica e Preventiva - Sezione Malattie Infettive, Seconda Università degli Studi di Napoli, Naples, Italy

    Silvano Esposito, Silvana Noviello, Alessandro Vanasia & Paola Venturino

Authors
  1. Silvano Esposito
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Silvana Noviello
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alessandro Vanasia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paola Venturino
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Silvano Esposito.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Esposito, S., Noviello, S., Vanasia, A. et al. Ceftriaxone versus Other Antibiotics for Surgical Prophylaxis. Clin. Drug Investig. 24, 29–39 (2004). https://doi.org/10.2165/00044011-200424010-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00044011-200424010-00004

Keywords

Search

Navigation