Randomized clinical trial of co-amoxiclav versus no antibiotic prophylaxis in varicose vein surgery

Mekako, A. I.; Chetter, I. C.; Coughlin, P. A.; Hatfield, Joanne; Hatfield, J.; McCollum, P. T.

Abstract

Background: Wound infection rates of up to 16 per cent are reported following varicose vein surgery and the value of antibiotic prophylaxis in clean surgery remains unclear. Methods: Some 443 patients undergoing varicose vein surgery randomly received a single prophylactic dose of 1•2 g co-amoxiclav (219 patients) or no antibiotic (224). Patients completed a wound diary on postoperative days 3, 5, 7, 9 and 10 using an adapted ASEPSIS method of wound assessment, and were reviewed after 14 days. Results: Patients who had prophylaxis had lower ASEPSIS wound scores on days 3, 5 and 7 (P = 0•043, P = 0•032 and P = 0•003 respectively), and lower total ASEPSIS scores (median (interquartile range) 3 (0-9) versus 6 (0-15); P = 0•013). They were less likely to consult their general practitioner (16.0 versus 24•3 per cent; P = 0•040) or to receive postoperative antibiotics (4•7 versus 13•5 per cent; P = 0•002) for wound-related problems. Wound outcomes were worse with higher body mass index (odds ratio (OR) 0•92 (95 per cent confidence interval (c.i.) 0•87 to 0•97); P = 0•005) and current smoking (OR 0•5 (0•3 to 0•9); P = 0•033). Prophylactic antibiotics conferred satisfactory wound healing (OR 2•2 (95 per cent c.i. 1•3 to 3•6); P = 0•003). Conclusion: Antibiotic prophylaxis reduced wound-related problems after varicose vein surgery. Registration number ISRCTN12467340 (http://www.controlled-trials.com). Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.

Citation

Mekako, A. I., Chetter, I. C., Coughlin, P. A., Hatfield, J., & McCollum, P. T. (2010). Randomized clinical trial of co-amoxiclav versus no antibiotic prophylaxis in varicose vein surgery. British journal of surgery, 97(1), 29-36. https://doi.org/10.1002/bjs.6849

• Journal Article Type: Article
• Acceptance Date: Aug 12, 2009
• Online Publication Date: Dec 10, 2009
• Publication Date: 2010-01
• Journal: BRITISH JOURNAL OF SURGERY
• Print ISSN: 0007-1323
• Electronic ISSN: 1365-2168
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 97
• Issue: 1
• Pages: 29-36
• DOI: https://doi.org/10.1002/bjs.6849
• Keywords: Surgery
• Public URL: https://hull-repository.worktribe.com/output/391495
• Publisher URL: http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=3&hid=8&sid=b1bb44c9-7726-4276-bff5-3966b765ec19%40sessionmgr12
• Related Public URLs: https://onlinelibrary.wiley.com/doi/abs/10.1002/bjs.5736
• Additional Information: Presented to a meeting of the Vascular Society of Great Britain and Ireland, Edinburgh, UK, November 2006, and published in abstract form as BJS 2007; 94: 254