Strongly consider Stopping Prophylactic Antibiotics after 24 hours in Penetrating Abdominal Trauma
Konstantinos Spaniolas MD
George C. Velmahos MD, PHD
Despite abundant evidence to the contrary, multiple and prolonged antibiotics are still used following penetrating abdominal trauma. In 515 randomized patients, Fabian et al. showed that 1 day of a second-generation cephalosporin prophylaxis was equally effective as 5 days of the same antibiotic. Cornwell et al., in a prospective randomized study of 63 high-risk patients with penetrating colon injury, found no difference in infectious morbidity between 1 and 5 days of a second-generation cephalosporin. Dellinger et al. randomized 116 patients with small or large bowel injuries to 12 hours versus 5 days of antibiotics and failed to identify any significant differences in morbidity or mortality. Velmahos et al., in a prospective study of 250 critically injured patients, found that antibiotic prophylaxis for penetrating abdominal trauma longer than 1 day did not decrease septic morbidity and was an independent risk factor for delayed resistant infection.
What to Do
Multiple studies have been performed comparing different types of antibiotics in penetrating abdominal trauma. Moxalactam, gentamicin with clindamycin, cefoxitin, cefotetan, cefotaxime, aztreonam, ampicillin/sulbactam, and piperacillin/tazobactam are some of the many prophylactic agents that have been tested. The general conclusion is that a single broad-spectrum antibiotic is as effective as multiple antibiotics. Second-generation cephalosporins have shown a decreasing efficacy in some studies, probably because of bacterial resistance from prolonged use or because of inability of enterococcal coverage. Ampicillin/sulbactam seems to be cost-effective and provides adequate coverage.