TY - JOUR
T1 - When should old therapies be abandoned? A modern look at old studies on topical ampicillin
AU - Charalambous, Charalambos
AU - Tryfonidis, Marios
AU - Swindell, Rick
AU - Lipsett, A. Pamela
PY - 2003
Y1 - 2003
N2 - Objective. We sought to determine whether topical ampicillin can reduce the rate of wound infections in clean contaminated surgical wounds (appendectomy, colorectal surgery). Method. All randomized controlled trials examining the use of topical ampicillin in appendectomy and colorectal surgery published in English were identified via a Medline, Advanced Medline, and Cochraine Controlled Trials Register search and a meta-analysis performed. Results. Topical ampicillin vs. no antibiotic prophylaxis in clean contaminated wounds significantly reduced surgical wound infection rates (Odds Ratio (OR) = 0.084, 95% CI, 0.04-0.16, P < 0.0001). Topical ampicillin vs. no antibiotic prophylaxis in contaminated wounds also reduced surgical wound infection (OR = 0.262, 95% CI, 0.14-0.51, P < 0.0001). Topical ampicillin combined with systemic antibiotics vs. systemic antibiotics alone did not reduce surgical wound infection rate (OR = 0.927, 95% CI, 0.27-1.72, P = 0.90). Conclusion. Topical ampicillin significantly reduces the rate of surgical wound infections in clean contaminated surgery. A significant but smaller effect is seen in appendectomies where the appendix is gangrenous or perforated. Topical ampicillin did not confer any additional benefit when systemic antibiotics are used. While ampicillin may no longer be an effective agent, topical application of antibiotics is effective. Summary. A meta-analysis of studies using topical ampicillin for the prevention of infection in clean contaminated wound suggests that topical ampicillin is effective, but no incremental benefit is seen with systemic antibiotics.
AB - Objective. We sought to determine whether topical ampicillin can reduce the rate of wound infections in clean contaminated surgical wounds (appendectomy, colorectal surgery). Method. All randomized controlled trials examining the use of topical ampicillin in appendectomy and colorectal surgery published in English were identified via a Medline, Advanced Medline, and Cochraine Controlled Trials Register search and a meta-analysis performed. Results. Topical ampicillin vs. no antibiotic prophylaxis in clean contaminated wounds significantly reduced surgical wound infection rates (Odds Ratio (OR) = 0.084, 95% CI, 0.04-0.16, P < 0.0001). Topical ampicillin vs. no antibiotic prophylaxis in contaminated wounds also reduced surgical wound infection (OR = 0.262, 95% CI, 0.14-0.51, P < 0.0001). Topical ampicillin combined with systemic antibiotics vs. systemic antibiotics alone did not reduce surgical wound infection rate (OR = 0.927, 95% CI, 0.27-1.72, P = 0.90). Conclusion. Topical ampicillin significantly reduces the rate of surgical wound infections in clean contaminated surgery. A significant but smaller effect is seen in appendectomies where the appendix is gangrenous or perforated. Topical ampicillin did not confer any additional benefit when systemic antibiotics are used. While ampicillin may no longer be an effective agent, topical application of antibiotics is effective. Summary. A meta-analysis of studies using topical ampicillin for the prevention of infection in clean contaminated wound suggests that topical ampicillin is effective, but no incremental benefit is seen with systemic antibiotics.
KW - Antibiotic prophylaxis
KW - Meta-analysis
KW - Surgical site infection
KW - Topical ampicillin
UR - http://www.scopus.com/inward/record.url?scp=0141828938&partnerID=8YFLogxK
U2 - 10.1016/S0163-4453(03)00071-9
DO - 10.1016/S0163-4453(03)00071-9
M3 - Article
C2 - 12963381
AN - SCOPUS:0141828938
SN - 0163-4453
VL - 47
SP - 203
EP - 209
JO - Journal of Infection
JF - Journal of Infection
IS - 3
ER -