Prospective, randomized, double-blind study of prophylactic antibiotics in axillary lymph node dissection

• Published in: The American journal of surgery 1998-09, Vol.176 (3), p.239-243
• Main Authors: Bold, Richard J, Mansfield, Paul F, Berger, David H, Pollock, Raphael E, Singletary, S.Eva, Ames, Frederick C, Balch, Charles M, Hohn, David C, Ross, Merrick I
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antibacterial agents; Antibiotic Prophylaxis - economics; Antibiotic Prophylaxis - methods; Antibiotic Prophylaxis - statistics & numerical data; Antibiotics. Antiinfectious agents. Antiparasitic agents; Axilla; Biological and medical sciences; Cefonicid - administration & dosage; Cefonicid - economics; Cephalosporins - administration & dosage; Cephalosporins - economics; Cost-Benefit Analysis; Double-Blind Method; Female; Humans; Infusions, Intravenous; Lymph Node Excision - economics; Lymph Node Excision - methods; Lymph Node Excision - statistics & numerical data; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Prospective Studies; Surgical Wound Infection - prevention & control
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(98)00154-8

Background: Antibiotic prophylaxis is controversial in patients undergoing axillary lymph node dissection (ALND). We determined whether preoperative antibiotics decreased incidence or treatment cost of infectious complications following ALND. Methods: Two hundred patients entered this prospective, randomized, double-blind trial. Patients received either placebo or cefonicid preoperatively. Loco-regional signs of infection were monitored for 4 weeks postoperatively. Results: There was a trend toward fewer infections in the prophylactic group (placebo 13% versus cefonicid 6%; P = 0.080). Cefonicid significantly decreased severe infections requiring hospitalization (placebo 8% versus cefonicid 1%; P = 0.033). Cefonicid also decreased the treatment cost of infection per patient ($49.80 versus $364.87). Conclusions: We demonstrated a trend toward fewer overall infections and significantly fewer severe infections in patients given prophylactic antibiotics, which translated into a decrease in the cost of treatment for infectious complications. These findings support antibiotic prophylaxis for patients undergoing ALND.