Antibiotikaprofylax vid kirurgiska ingrepp - SBU

Table 4.1.4 Laparascopic cholecystectomy.
Author
Year
Reference
Country
Study
design
Population
characteristics
Intervention
Method
Number individuals
Control
Number
indiviuduals
Results
Withdrawal
Drop outs
Study quality
and relevance
Comments
Agrawal
1999
[20]
Nepal
CT
Compare 2nd, 3rd
generation. Cephalosporins
vs fluoroquinolones.
Defined
SSI. Double blind.
Follow-up 14 days
I1: Ciprofloxacin 200 mg iv
at surgical incision + 12 later
(n=45)
I2: Ciprofloxacin 200 mg iv
post-op q 12 h for 2 days
(n=35)
I3: Cefuroxime (n=45) 750 mg
iv at incision + 12 h later
C: No ab SSI
I1: 2 (4.4%)
I2: 9 (25.7%)
I3: 3 (6.6%)
C: 8 (26.7%)
Not stated
Moderate
Ciprofloxacin should be
given pre-op. Can be
recommended, equally
effective as cefuroxime
Al-Ghnaniem
2003
[33]
United
Kingdom
Metaanalysis
5 studies. 3 RCT and
2 comparisons to
no ab. SSI defined
I: ab 1–3 doses cephalosporin
prophylaxis (n=528)
C: No ab SSI
I: 8 pts with infection
(1.5%) OR 0.68
(95% CI 0.24–1.91)
NNT 156 pts
C: 8 pts (2.2%)
High
No prophylaxis should be
given. Risk pts excluded:
acute cholecystitis,
CBC, jaundice, immune
depression or prosthetic
implants
Catarci
2004
[37]
Italy
Metaanalysis
6 RCT 1997–2001.
All in meta-analysis
by Al-Ghnaniem [33].
974 pts (1 051 from
beginning) SSI
I: Cephalosporins C: No ab SSI
I: 2.8% OR 0.69
(95% CI 0.34–1.43)
C: 4.40%
NNT 63
Moderate
No indication for ab. Risk
factors: Acute cholecystitis,
pancreatitis, jaundice,
immunosuppression, prosthesis.
Authors conclude
that larger study should
be performed with 990
pts per arm
Chang
2006
[10]
Taiwan
RCT
277 pts with elective
LC. 10% acute cholecystitis.
Post-op
infection by CDC.
Pts blinded. Follow-up
4 weeks
I: Cefazolin 1 g at time
of induction (n=141)
C: Saline (n=136) SSI
I: 1 pt (1.1%)
C: 2 pts (1.5%)
0 High
Well controlled for risk
factors, spillage etc in
meta-analysis [65]
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