Use of antibiotic prophylaxis in elective inguinal hernia repair in adults in London and south-east England: a cross-sectional survey Recurrent urinary tract infection. Re-emphasis of priorities in surgical antibiotic prophylaxis. Effects of Antibiotics on Dental Implants: A Review The Role of Antibiotic Prophylaxis in Prevention of Wound Infection After Lichtenstein Open Mesh Repair of Primary Inguinal Hernia: A Multicenter Double-Blind Randomized Controlled Trial Prophylactic Antibiotics in Open Fractures: A Pilot Randomized Clinical Safety Study Cefazolin versus Cefazolin plus Metronidazole for Antibiotic Prophylaxis at Cesarean Section Cefepime vs. Ampicillin/Sulbactam and Aztreonam as antibiotic prophylaxis in neurosurgical patients with external ventricular drain: result of a prospective randomized controlled clinical trial. Metronidazole in Head and Neck Surgery—The Effect of Lengthened Prophylaxis Antibiotic prophylaxis in vascular reconstructive surgery: a double-blind placebo-controlled study. Routine antibiotic prophylaxis is not necessary during operations to remove third molars. Influence of broad-spectrum antibiotic prophylaxis on intracranial pressure monitor infections and subsequent infectious complications in head-injured patients. Adherence to international antimicrobial prophylaxis guidelines in cardiac surgery: a Jordanian study demonstrates need for quality improvement. Antibiotics in trauma and orthopedic surgery -- a primer of evidence-based recommendations. The outcome of stopping prophylactic antibiotics in older children with vesicoureteral reflux. Antibiotic prophylaxis in permanent pacemaker implantation: a prospective randomised trial. Antibiotic prophylaxis for hysteroscopy evaluation of the uterine cavity. Prophylactic antibiotics in open mesh repair of inguinal hernia - a randomized controlled trial. Cost of Antibiotic Prophylaxis in Cesarean Section
Purpose Evidence regarding whether or not antibiotic prophylaxis is beneficial in preventing post-operative surgical site infection  in adult inguinal hernia repair is conflicting . A recent Cochrane review based on 17 r and omised trials did not reach a conclusion on this subject . This study aim ed to describe the current practice and determine whether clinical equipoise is prevalent . Methods Surgeons in training were recruited to administer the Survey of Hernia Antibiotic Prophylaxis usE survey to consultant-level general surgeons in London and the south-east of Engl and on their practice s and beliefs regarding antibiotic prophylaxis in adult elective inguinal hernia repair . Local prophylaxis guidelines for the participating hospital sites were also determined . Results The study was conducted at 34 different sites and received completed surveys from 229 out of a possible 245 surgeons , a 93 % response rate . Overall , a large majority of hospital guidelines ( 22/28 ) and surgeons ’ personal beliefs ( 192/229 , 84 % ) supported the use of  single-dose pre-operative intravenous antibiotic prophylaxis  in inguinal hernia repair , although there was considerable variation in the regimens in use . The most widely used regimen was intravenous co-amoxiclav ( 1.2 g ) . Less than half of surgeons were adherent to their own hospital antibiotic guidelines for this procedure , although many incorrectly believed that they were following these . Conclusion In the south-east of Engl and , there is a strong majority of surgical opinion in favour of the use of antibiotic prophylaxis in this procedure . It is therefore likely to be extremely difficult to conduct further r and omised studies in the UK to support or refute the effectiveness of prophylaxis in this commonly performed procedure OBJECTIVE to provide an up date of the definition , epidemiology , clinical presentation , investigation , treatment , and prevention of  recurrent urinary tract infections in women . OPTIONS continuous antibiotic prophylaxis , post-coital antibiotic prophylaxis , and acute self-treatment are all efficient alternatives to prevent recurrent urinary tract infection . Vaginal estrogen and cranberry juice can also be effective prophylaxis alternatives . EVIDENCE a search of PubMed and The Cochrane Library for articles published in English identified the most relevant literature . Results were restricted to systematic review s , r and omized control trials/controlled clinical trials , and observational studies . There were no date restrictions . VALUES this up date is the consensus of the Sub-Committee on Urogynaecology of the Society of Obstetricians and Gynaecologists of Canada . Recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care ( Table 1 ) . OPTIONS recurrent urinary tract infections need careful investigation and can be efficiently treated and prevented . Different prophylaxis options can be selected according to each patient 's characteristics The results of two prospect i ve , r and omized trials , comparing single dose piperacillin with multidose cefoxitin prophylaxis in elective surgical procedures of the gastrointestinal tract were combined to examine some basic aspects of clinical ly , applied antibiotic prophylaxis . As there was no difference in the efficacy of prophylaxis between the groups , data from both centers and both drug groups were combined for analysis . Patients whose ages were greater than 40 years , the presence of cancer and the administration of an antibiotic for longer than 60 minutes preoperatively were associated with a higher rate of infectious complications . Duration of operation was also related to subsequent infection , ranging from 6 per cent in procedures lasting less than two hours to 27 per cent in operations lasting more than four hours . There was a greater failure of prophylaxis in patients undergoing rectal procedures , with a 29 per cent rate of infectious complications compared with 14 per cent in patients undergoing operations upon the colon . This difference was present even when duration of operation was taken into account There are many reasons for dental implant failure , the development of bacteremia is concern for dentists . This is due to the possibility of unfavorable result such as implant loss or the need for re-treatment . In general , antibiotic prophylaxis is recommended for high risk patients such as individuals with an immunodeficiency , infectious endocarditis , or previous prosthetic instrumentation . However regarding clinical ly healthy , low and moderate risk individuals the use of antibiotics in implant dentistry is controversial . Another major concern regarding the over prescription of antibiotics is the selection of antibiotic resistant bacteria . A better underst and ing of the efficacy of prophylactic treatments regarding dental implantation is crucial . Thus a literature review and comparison of survival rates of dental implants with regimens of no , pre or post prophylaxis was performed using systematic literature review using reliable electronic data bases . Retrospective or prospect i ve controlled studies were examined for the influence of preoperative and /or postoperative or no antibiosis on dental implant success rate . Of the 11406 implants used in this literature review , cases with no antibiotics had a 92 % success rate , cases with pre-op antibiotic alone had a 96 % success rate , cases with post-op antibiotic alone had a 97 % success rate and cases with both pre and post-op antibiotic had a success rate of 96 % . Thus , the results from this literature review show a > 90 % success rate when antibiotics are used compared to when they are not used . Thus , no benefit is seen from the use of antibiotic prophylaxis in low and moderate risk dental implant patients . Keywords Dental implants ; Pre-operative prophylactics ; Post-operative prophylactics ; Success Objective : To determine whether the use of prophylactic antibiotics is effective in the prevention of postoperative wound infection after Lichtenstein open mesh inguinal hernia repair . Summary Background Data : A recent Cochrane meta- analysis ( 2003 ) concluded that “ antibiotic prophylaxis for elective inguinal hernia repair can not be firmly recommended or discarded . ” Methods : Patients with a primary inguinal hernia scheduled for Lichtenstein repair were r and omized to a preoperative single dose of 1.5 g intravenous cephalosporin or a placebo .  Patients with recurrent hernias , immunosuppressive diseases , or allergies for the given antibiotic were excluded . Infection was defined using the Centers for Disease Control and Prevention criteria . Results : We included 1040 patients in the study between November 1998 and May 2003 . According to the intention-to-treat principle , 1008 patients were analyzed . There were 8 infections ( 1.6 % ) in the antibiotic prophylaxis group and 9 ( 1.8 % ) in the placebo group ( P = 0.82 ) . There was 1 deep infection in the antibiotic prophylaxis group and 2 in the placebo group ( P = 0.57 ) . Statistical analysis showed an absolute risk reduction of 0.19 % ( 95 % confidence interval , −1.78%–1.40 % ) and a number needed to treat of 520 for the total number of infections . For deep infection , the absolute risk reduction is 0.20 % ( 95 % confidence interval , −0.87%–0.48 % ) with a number needed to treat of 508 . Conclusions : A low percentage ( 1.7 % ) of wound infection after Lichtenstein open mesh inguinal ( primary ) hernia repair was found , and there was no difference between the antibiotic prophylaxis or placebo group . The results show that , in Lichtenstein inguinal primary hernia repair , antibiotic prophylaxis is not indicated in low-risk patients Objective : To develop preliminary data on Staphylococcus aureus colonization and surgical site infections ( SSIs ) in patients with open fractures who received st and ard antibiotic prophylaxis  compared with a regimen including targeted methicillin-resistant Staphylococcus aureus ( MRSA ) coverage . Design : R and omized prospect i ve clinical trial . Patients : Adult patients who presented to the emergency department with an open fracture between April 2009 and July 2011 . Interventions : One hundred thirty patients were r and omized to receive prophylaxis with either cefazolin alone ( control arm ) or vancomycin and cefazolin ( experimental arm ) from presentation to the emergency department until 24 hours after the surgical intervention . Screening for S. aureus carriage was performed with nares swabs and predebridement and postdebridement open fracture wound swabs . Patients underwent prospect i ve assessment for the development of SSI for no less than 30 days and up to 12 months . Results : Nasal colonization of methicillin-sensitive S. aureus and MRSA among the sample was 20 % and 3 % , respectively . No significant difference in the rates of SSI was observed between the study arms ( 15 % vs 19 % , respectively , P = 0.62 ) . Staphylococcus aureus caused 55 % of the deep incisional/organ space SSI , with 18 % attributed to MRSA . A significantly higher rate of MRSA SSIs was observed among MRSA carriers compared with noncarriers ( 33 % vs 1 % , respectively , P = 0.003 ) . Conclusions : Staphylococcus aureus nasal colonization in trauma patients with open fractures is similar to that of the general community . In this pilot study , the addition of vancomycin to st and ard antibiotic prophylaxis was found safe , but its efficacy should be evaluated in a larger multiinstitutional trial . Level of Evidence : Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence Background Although prophylactic antibiotic medications have been shown to reduce the incidence of postoperative infectious morbidity after cesarean delivery , the most effective regimens have not been established . The purpose of this investigation was to compare the efficacy and costs of prophylaxis with cefazolin alone with cefazolin plus metronidazole . Methods Women undergoing cesarean delivery were r and omized to prophylaxis with 2 g cefazolin ( n = 81 ) or 1 g cefazolin plus 500 mg metronidazole  ( n = 79 ) . Postoperative infectious morbidity and the duration of hospitalization in the two groups were compared . Results Thirty-seven ( 23 % ) of 160 patients developed endomyometritis . There was a significant reduction in the number of postoperative infections ( 14 versus 32 % ) and hospital days ( 3.12 versus 4.46 ) with cefazolin and metronidazole prophylaxis ( P = 0.0064 versus P = 0.014 ) compared with cefazolin alone . The estimated antibiotic prophylaxis cost per person was less with cefazolin and metronidazole than with cefazolin alone ( $ 9.12 versus $ 26.73 ) . Conclusion Antibiotic prophylaxis with metronidazole and cefazolin results in fewer postoperative infections , decreased duration of hospitalization , and lower medication cost than cefazolin alone INTRODUCTION We aim ed to find out whether single board spectrum antibiotic prophylaxis was as good as dual specific antibiotic prophylaxis in neurosurgical patients with external ventricular drain ( EVD ) in situ . METHOD In a 2-year period , 255 eligible patients were recruited . Patients were r and omized into two groups of antibiotic prophylaxis as long as the ventricular catheter in situ . Group A employed Cefepime 2 G 12 hourly and Group B employed dual antibiotics as Ampicillin/Sulbactam 3 g 8 hourly and Aztrenam 2 g 8 hourly . RESULTS There was no statistically significant difference in cerebrospinal fluid ( CSF ) infection rate with 14 patients ( 11.5 % ) in group A ( Cefepime prophylaxis ) and eight patients ( 6.0 % ) in group B ( dual prophylaxis with Ampicillin/Sulbactam and Aztrenam ) had CSF infection ( P=0.18 ) . There was also no statistical significant difference between wound infection rate happened in eight patients ( 6.6 % ) in Group A and three patients ( 2.3 % ) in Group B ( P=0.17 ) . There was no statistical significant difference in extracranial infection rate between both groups ( P=0.70 ) . CONCLUSION Single board spectrum antibiotic prophylaxis with Cefepime was an effective alternative regimen for neurosurgical patients with an EVD in situ Previous studies of antibiotic prophylaxis have shown that treatment for 24 hours has been beneficial for head and neck surgery and that longer periods of antibiotic therapy have not improved results . Metronidazole ( Flagyl ) , unlike other antibiotics tested , has been shown to be effective in an experimental abscess , even if treatment is begun up to 120 hours after administration of inoculum . This article presents a prospect i ve , r and omized , multifactorial study comparing a brief vs. a prolonged duration of metronidazole and cefazolin prophylaxis in 50 consecutive patients with a head and neck cancer undergoing operation . Patients receiving 2 days vs. 7 or more days of antibiotic prophylaxis were compared . Statistical analysis of data demonstrated a striking reduction in severity of wound complications and a reduced incidence of wound infections in the group treated with 7 or more days of antibiotic prophylaxis In a prospect i ve r and omized double-blind study of 141 patients referred for reconstructive vascular surgery on the abdominal aorta and the lower extremities , placebo was compared to antibiotic prophylaxis . The prophylaxis group received three doses of a combination of methicillin , 2 g and netilmicin , 200 mg . Antibiotic prophylaxis reduced postoperative wound infections as compared to placebo , i.e. 4/69 ( 5.8 % ) vs. 12/72 , ( 16.7 % ) respectively ( P = 0.04 ) . No graft infections occurred . Two cases of postoperative septicaemia were seen in the placebo group , none in the antibiotic group . Among different procedures aortic-femoral bypass operations showed the highest wound infection rates . The two treatment groups were comparable with regard to all other postoperative complications registered , including nephro- and ototoxicity . The antibiotic regimen was considered safe , but had only marginal value as prophylaxis in vascular reconstructive surgery on the abdominal aorta and the lower extremities The purpose of this study was to evaluate the efficacy of antibiotic prophylaxis during removal of impacted third molars . We studied 150 patients with impacted m and ibular or maxillary third molars who were divided r and omly into three groups . The first was given amoxicillin 2 g combined with clavulanic acid , orally daily for 5 days postoperatively ; starting at the end of the operation . The second group was given the same drugs but the regimen started 5 days before the operation . The third was given no antibiotics .  Pain , infection , swelling , alveolar osteitis , and interincisal mouth opening ( mm ) were evaluated . There were no significant differences among the groups in the incidence of these complications . We can not recommend routine oral antibiotic prophylaxis in third molar surgery BACKGROUND The benefit of antibiotic prophylaxis for intracranial pressure ( ICP ) monitors remains controversial , and clinical practice varies widely . Whether any antibiotic coverage , particularly broad-spectrum coverage , reduces monitor-related infections remains unproved , and exposure to antibiotics may affect the susceptibility patterns of pathogens producing subsequent infectious complications . Despite the lack of data supporting its use , our level I trauma center had a long-st and ing ICP monitor prophylaxis protocol that provided broad-spectrum coverage that included ceftriaxone . In April 2002 , a protocol change was instituted that substituted cefazolin for ceftriaxone as single-agent prophylaxis for ICP monitors . HYPOTHESIS Broader-spectrum antibiotic prophylaxis does not reduce ICP monitor-related infections but is associated with acquisition of more drug-resistant infections than narrow-spectrum prophylaxis . METHODS To evaluate the influence of broad- versus narrow-spectrum prophylaxis , a three year period encompassing each practice was selected . All injured patients with ICP monitors placed between January 1 , 2001 , and December 31 , 2003 ( n = 279 ) , were identified using the V and erbilt trauma data base . Antibiotic prophylaxis for ICP monitors was determined using the hospital financial data base to identify all antibiotics given to individual patients and subsequent chart review to identify those antibiotics given solely for ICP prophylaxis . A total of 119 patients received narrow-spectrum ( either cefazolin or vancomycin ; n = 100 ) or no ( n = 19 ) prophylaxis , whereas 160 received broad-spectrum prophylaxis ( ceftriaxone or ciprofloxacin ) . The two groups did not differ with respect to baseline demographics , type of ICP monitor , or duration of monitor placement . Infectious complications were determined by continuous infection surveillance utilizing st and ard U.S. Centers for Disease Control and Prevention National Nosocomial Infection Surveillance System ( CDC-NNIS ) definitions and maintained in a contemporary data base . The influence of broad-spectrum antibiotic prophylaxis on both ICP monitor infections and subsequent infections outside the central nervous system ( CNS ) was determined . RESULTS Nine patients ( 3.2 % ) developed CNS infections ; two of 119 patients ( 1.7 % ) who received narrow-spectrum or no prophylaxis versus seven of 160 patients ( 4.4 % ) who received broad-spectrum prophylaxis ( p = NS ) . Only the duration of monitor placement and Injury Severity Score were associated with the infection rate . In the total population , 185 infections occurred in 93 patients ( 33 % ) . Infection rates did not differ between patients who received narrow-spectrum or no prophylaxis ( 32 % ) and those who received broad-spectrum prophylaxis ( 34 % ) . However , patients who received broad-spectrum prophylaxis acquired gram-negative infections with significantly greater antibiotic resistance . CONCLUSIONS Broad-spectrum antibiotic prophylaxis of ICP monitors does not reduce CNS infections , but is associated with a shift to resistant gram-negative pathogens in subsequent infectious complications . Thus , broad-spectrum antibiotic prophylaxis of ICP monitors should be eliminated or minimized unless data from r and omized trials prove its utility BACKGROUND Antimicrobial prophylaxis in cardiac surgery has been demonstrated to lower the incidence of surgical site infection ( SSI ) . Inappropriate antimicrobial prophylaxis , such as inappropriate selection of the antimicrobial agent or inappropriate dosing regimen , can increase the prevalence of antibiotic resistant strains , prolong hospital stay , cause adverse reactions , and negatively affect an institution 's pharmacy budget for antibiotics . In developing countries such as Jordan , where the role of clinical pharmacists is still in its primary stages , the first step in establishing an organized clinical pharmacy service is the evaluation of current practice to determine the need for improvement . OBJECTIVE To assess the degree of adherence to international guidelines for antimicrobial prophylaxis practice in cardiac surgery performed at Queen Alia Heart Institute ( QAHI ) in Amman , Jordan , as part of an attempt to determine opportunities for clinical pharmacist intervention . METHODS For a total of 236 patients who were admitted for cardiac surgery to QAHI - the only official referral hospital for cardiac patients in Jordan - between November 19 , 2006 , and January 22 , 2007 , the antimicrobial prophylaxis indication , choice , duration , dose , dosing interval , and timing appropriateness were assessed against 3 international guidelines using a pre-tested , structured clinical data collection form that was completed by 2 of the authors who work at QAHI . The study design was prospect i ve . All patients who were scheduled for surgery were monitored daily during their inpatient stay until discharge and then were tracked in the outpatient clinic for 2 months following surgery . Data regarding antimicrobial prophylaxis indication , choice , duration , dose , dosing interval , and timing appropriateness were collected during the patient 's inpatient stay ; data collection was performed periodically thereafter as data became available until the end of the 2-month follow-up . The 3 guidelines agreed that ( a ) antimicrobial prophylaxis should be given to all patients undergoing cardiac surgeries ; ( b ) the first- or second-generation cephalosporins ( cefazolin or cefuroxime ) are the antibiotics of choice , and vancomycin use is reserved for cases of allergy to beta-lactams or if presumed or known methicillin-resistant Staphylococcus aureus ( MRSA ) colonization is present ; ( c ) the timing of the first dose should be within 60 minutes prior to the skin incision ; and ( d ) the duration of antimicrobial prophylaxis should not be longer than 48 hours . RESULTS Adherence to all antimicrobial prophylaxis guidelines was not achieved for any study patients . For the 6 evaluated criteria , ( 1 ) indication : in 100 % of patients the appropriate decision was made to use antimicrobial prophylaxis in concordance with guidelines ; ( 2 ) choice : only 1.7 % of patients received the antibiotic of choice ; ( 3 ) duration : 39.4 % of patents received antimicrobial prophylaxis for a total duration of 48 hours or less in concordance with guidelines , and for 58.9 % of patients , duration was longer than recommended ; ( 4 ) dose : 27.9 % of patients received an appropriate dose ; ( 5 ) dosing interval : only 13.0 % of patients received an appropriate dosing interval , and none of the doses of antimicrobial prophylaxis used at induction of anesthesia was repeated in operations that lasted longer than the half-life of the antibiotic used ; and ( 6 ) timing : 99.1 % of patients received antimicrobial prophylaxis dose within 60 minutes prior to skin incision as recommended by guidelines , but 97.0 % of patients received an unnecessary midnight dose of intravenous antibiotic the night before surgery . CONCLUSION Study findings indicate that adherence to international guidelines for antimicrobial prophylaxis is far from optimal in QAHI , leading to the inappropriate administration of many antibiotics . Developing local hospital guidelines , as well as giving the clinical pharmacist a central role in the administration , monitoring , and intervention of antimicrobial prophylaxis may improve the current practice Systematic review s and meta-analyses published in recent years have allowed drafting of evidence -based guidelines for antibiotic prophylaxis in orthopedic and trauma surgery . It is important to recognize the limitations of the recommendations derived from the available body of evidence . Since some of the most relevant r and omized controlled clinical trials were performed more than 20 years ago , it is sometimes difficult to apply the data to today 's clinical practice . In establishing consensus guidelines , it could prove difficult to identify areas for improvement through further research and better compliance . Although recommendations for optimized treatment of orthopedic implant infections are not currently based on first-class evidence , there are very promising new concepts emerging in this field , and we are awaiting more data and decisive conclusions from larger clinical trials PURPOSE Accepted management of vesicoureteral reflux includes surgical correction or prophylactic antibiotics with the hope for resolution as the child grows . The physician must consider surgery when reflux does not resolve despite uneventful years on prophylactic antibiotics . An alternative is cessation of the antibiotics . We report on the outcome of children taken off antibiotics  with persistent reflux . MATERIAL S AND METHODS During a 14-year period 51 children with documented reflux were taken off antibiotic prophylaxis . Selection criteria included children who were old enough to verbalize the symptoms of a urinary tract infection , and had normal voiding patterns , a minor history of infections and minimal or no renal scarring . Routine followup included nuclear cystography and renal sonography . RESULTS A total of 40 girls and 11 boys maintained on antibiotics for a mean of 4.8 years were taken off prophylaxis and followed for an average of 3.7 years . Mean patient age when prophylactic antibiotics were stopped was 8.6 years . Reflux resolved in 10 children ( 19.6 % ) . A urinary tract infection developed in 5 girls and 1 boy ( 11.8 % ) ( mean age 11 ) an average of 2.3 years ( range 4 months to 9.4 years ) after antibiotic discontinuation . One child had symptoms consistent with cystitis and 5 had febrile urinary tract infections . All were treated with oral antibiotics and 5 had subsequent operations . No new renal scars developed . CONCLUSIONS The majority of children did well following cessation of antibiotic prophylaxis despite persistent vesicoureteral reflux . Cessation of antibiotic prophylaxis is a reasonable option in a highly select patient population with reflux BACKGROUND --Pacemaker pocket infection is a potentially serious problem after permanent pacemaker implantation .  Antibiotic prophylaxis is commonly prescribed to reduce the incidence of this complication , but current trial evidence of its efficacy is conflicting . A large prospect i ve r and omised trial was therefore performed of antibiotic prophylaxis in permanent pacemaker implantation . The intention was firstly to determine whether antibiotic prophylaxis is efficacious in these patients and secondly to identify which patients are at the highest risk of infection . METHODS --A prospect i ve r and omised open trial of flucloxacillin ( clindamycin if the patient was allergic to penicillin ) v no antibiotic was performed in a cohort of patients undergoing first implantation of a permanent pacing system over a 17 month period .  Intravenous antibiotics were started at the time of implantation and continued for 48 hours . The trial endpoint was a repeat operation for an infective complication . RESULTS --473 patients were entered into a r and omised trial . 224 received antibiotic prophylaxis  and 249 received  no antibiotics . A further 183 patients were not r and omised but were treated according to the operator 's preference ( 64 antibiotics , 119 no antibiotics ) ; these patients are included only in the analysis of predictors of infection . Patients were followed up for a mean ( SD ) of 19(5 ) months . Among the patients in the r and omised group there were nine infections requiring a repeat operation , all in the group not receiving antibiotic ( P = 0.003 ) . In the total patient cohort there were 13 infections , all but one in the non-antibiotic group ( P = 0.006 ) . Nine of the infections presented as erosion of the pulse generator or electrode , three as septicaemia secondary to Staphylococcus aureus , and one as a pocket abscess secondary to Staphylococcus epidermidis . Infections were significantly more common when the operator was inexperienced ( < or = 100 previous patients ) , the operation was prolonged , or after a repeat operation for non-infective complications ( principally lead displacement ) . Infection was not significantly more common in patients identified preoperatively as being at high risk ( for example patients with diabetes mellitus , patients receiving long term steroid treatment ) , although there was a trend in this direction . CONCLUSIONS --Antibiotic prophylaxis significantly reduced the incidence of infective complications requiring a repeat operation after permanent pacemaker implantation . It is suggested that antibiotics should be used routinely OBJECTIVE To assess the prevalence of infectious complications and the protective effect of  prophylactic antibiotic treatment  after diagnostic office hysteroscopy in asymptomatic , infertile patients with normal results from transvaginal sonography . DESIGN Recording of infectious complications after routine hysteroscopy in the context of a r and omized controlled trial ; pseudor and omized , center-specific application of antibiotic prophylaxis . SETTING Two tertiary infertility care units . PATIENT(S ) Six hundred thirty-one unselected , asymptomatic , infertile women who underwent routine , diagnostic hysteroscopy prior to a first in vitro fertilization ( IVF ) or intracytoplasmic sperm injection treatment .  INTERVENTION(S ) Depending on the hospital and according to local protocol s , hysteroscopy was performed with or without antibiotic prophylaxis . MAIN OUTCOME MEASURE(S ) The prevalence of infectious complications after routine hysteroscopy .  RESULT ( S ) Of the 631 women who underwent routine , diagnostic hysteroscopy ,  antibiotic prophylaxis  was prescribed to 266 women , whereas 365 women underwent the procedure without prophylaxis . Only one infectious complication occurred ( 0.4 % ) in a patient who had not undergone therapeutic interventions and had taken antibiotic prophylaxis . This complication was successfully treated with antibiotics on an outpatient basis . CONCLUSION ( S ) Considering the extremely low risk of infectious complications and the lack of evidence , suggesting a beneficial effect of antibiotic prophylaxis , its use for routine , diagnostic office hysteroscopy should not be recommended The role of prophylactic antibiotics in mesh repair of inguinal hernia is unclear . A Cochrane meta- analysis in 2005 concluded that " antibiotic prophylaxis for elective inguinal hernia repair can not be firmly recommended or discarded " and " further studies are needed , particularly on the use for mesh repair . " So , we design ed a study to define the role of prophylactic antibiotics in mesh repair of inguinal hernia . We conducted a prospect i ve , r and omized , double-blind , trial comparing wound infection rates in 450 patients ( 225 received intravenous Cefazolin , 225 received a placebo ) undergoing primary inguinal hernia repair electively using polypropylene mesh . 334 patients who completed a followup period of one month were analyzed . Age , American Society of Anesthesiologists class , type of hernia , type of anesthesia , grade of surgeon , pre and postoperative hospital stay and duration of operation were recorded . CDC criteria was used to define wound infection . Groups were well matched for all preoperative variables studied . The overall infection rate was 8.7 % ( 29 out of 334 ) . The incidence of wound infection in antibiotic group was 7 % and 10.5 % in control group . One from each group developed deep surgical site infection . Most of the infections occurred between the 7th and 12th post-operative day after discharge from the hospital . Antibiotic prophylaxis was associated with decreased incidence of wound infection when compared to control group , but the difference was not statistically significant . Based on our results we do not recommend the routine use of antibiotic prophylaxis in elective mesh repair of inguinal hernias Two hundred sixty-three patients were r and omly assigned to receive either piperacillin or cefoxitin for prophylaxis in cesarean section . Although both drugs were considered effective , piperacillin achieved a level of 98 percent satisfactory prophylaxis compared with only 91 percent for cefoxitin .  Costs of prophylactic failure in cesarean section were calculated and then assessed for four different antibiotic regimens ( based on 100 patients ) . Because of its high failure rate , ampicillin was the most expensive antibiotic ; piperacillin was the least expensive . It was suggested that highly effective prophylaxis with an antibiotic agent such as piperacillin can result in significant cost savings when used for high-risk patients undergoing cesarean section
Results of r and omized controlled trials performed to date provide evidence that antibiotic prophylaxis reduces subsequent infection and that courses as short as one day are as effective as courses of three to five days , although the evidence warrants only low to moderate confidence .
BACKGROUND The purpose of the present study was to perform a systematic review and meta- analysis of the use of alternative antibiotic regimens-including ( A ) antibiotic prophylaxis versus no prophylaxis , ( B ) longer versus shorter duration of antibiotic prophylaxis , and ( C ) alternative drugs-for  patients with open fracture of the extremities .