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Antibiotic May Be Superior in Preventing Surgical Infection

Ertapenem better than cefotetan in preventing infection in study of colorectal surgery

WEDNESDAY, Dec. 20 (HealthDay News) -- The antibiotic ertapenem may be more effective than cefotetan in preventing surgical-site infections in patients undergoing colorectal surgery, according to study findings published in the Dec. 21 issue of the New England Journal of Medicine.

Kamal M.F. Itani, M.D., from Boston University Medical School, and colleagues randomly assigned 1,002 patients undergoing elective colorectal surgery to a single dose of 1 gram of ertapenem or 2 grams of cefotetan given within an hour before the first surgical incision. The final analysis included 334 cefotetan patients and 338 ertapenem patients who were evaluated four weeks after surgery.

The researchers found that prophylactic failure occurred in 42.8 percent of cefotetan patients and 28 percent of ertapenem patients. Surgical site infection was the most common reason for failure, occurring in 26.2 percent and 17.1 percent of cefotetan and ertapenem patients, respectively. There was a statistically insignificant increase in Clostridium difficile infection in the ertapenem patients (1.7 vs. 0.6 percent).

"Even though the authors demonstrated that ertapenem was superior to cefotetan in this trial, is it reasonable to conclude that ertapenem should be a preferred agent for prophylaxis before colorectal surgery?" according to an accompanying editorial. "Only one-third of Medicare patients undergoing colorectal surgery currently receive cefotetan as prophylaxis, and there are numerous other antibiotic regimens with a long track record of safety and efficacy."

The study was supported by Merck.

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