Ceftriaxone or cefazolin prophylaxis for the prevention of infection after vaginal hysterectomy

A prospective, double-blind, perioperative prophylactic antibiotic study was performed in 127 women undergoing vaginal hysterectomy. Patients were randomly given a preoperative 1 g dose of ceftriaxone and then placebo 8 and 16 hours later or three 1 g doses of cefazolin over 16 hours. At surgery, blood samples were collected from 81 women and vaginal mucosa samples, from 49 women. Respective antibiotic concentrations were determined by high-pressure liquid chromatography. During the 10 months of this study, 64 patients received ceftriaxone and 63 received cefazolin. Clinical and surgical profiles of the two groups were similar, and the incidence of postoperative pelvic infection was identical, being 1.6 percent. The mean concentration of ceftriaxone was significantly higher than that of cefazolin in serum (p < 0.001) and vaginal mucosa (p < 0.05). A single dose of ceftriaxone before surgery was as effective in preventing major pelvic infection and urinary tract infection as were three perioperative doses of cefazolin given over 16 hours. The safety and tolerance of the two regimens were equivalent.