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,ntroduction 

In surgery antibiotic prophylaxis refers to the adminis-
tration of antimicrobial agents to patients without 
evidence of established infection with the objective of 
reducing subsequent post-operative septic compli-
cations (Nichols, 1981). The antimicrobial is given 
intravenously just prior to or 1 hour before induction of 
anesthesia. 

The general principles of antimicrobial chemoprophy-
laxis should be directed towards specific pathogen and 
there should be no development of drug resistance 
during the period of therapy and it should be used for 
a limited duration as well. Moreover, conventional 
therapeutic doses should be employed and prophylaxis 
should be employed only in situations of documented 
drug efficacy (Trevor, 2002). Prophylactic antibiotics 

exert their greater effect in clean–contaminated surgical 
procedures (Relman, 1982). 

Metronidazole has been found to be effective in general 
and gynecologic surgery, in which anerobes constitute 
a large act of the colonizing bacterial flora (Kaiser, 
1986). Cefazolin penetrates well in most tissues. It is a 
drug of choice for surgical prophylaxis (Chambers, 
2007). Ciprofloxacin and metronidazole are also used 
as prophylaxis in abdominal hysterectomy (Rahman, 
2005). 

The most critical factors in the prevention of post-
operative infections, although difficult are the sound 
judgment and proper technique of the surgeon and 
surgical team, as well as the general health and disease 
state of the patient (Nichols, 2001). 

Intra-abdominal infections are polymicrobial and result 

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Impact of prophylactic use of antimicrobials in abdominal surgery 
in two tertiary level hospitals 
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Received:                             9 May 2008 
Accepted:                          15 June 2008 
Available Online:             16 June 2008  
 
DOI: 10.3329/bjp.v3i2.837 
 
 
 
 
 
 

 
Cite this article: 
Saha S, Ashrafuzzaman S. Impact of 
prophylactic use of antimicrobials in 
abdominal surgery in two tertiary 
level hospitals. Bangladesh J Pharma-
col. 2018; 13: 80-82. 

$EVWUDFW 

Post-surgical infections are polymicrobial and it is an important cause of 
morbidity and mortality. The combination of ciprofloxacin plus metronida-
zole as well as several ß-lactum based regimens are commonly used regimens 
for the treatment of patients with such infections.  Three hundred patients 
(age range 25-40 years) were taken from two teaching hospitals for inter-
ventional study. When patients were selected for appenditectomy or 
cholecystectomy, either ciprofloxacin plus metronidazole or cephalosporin 
plus metronidazole were given intravenously. The patients were then divided 
into 4 groups. Group I and II received drugs ciprofloxacin plus metronidazole 
and cephalosporin plus metronidazole in SSMC respectively and Group III 
and IV received drugs ciprofloxain plus metronidazole and cephalosporin 
plus metronidazole in DNMC respectively. There were 33 cases of infections 
out of total 300 study subjects. It was observed that in SSMC among 
ciprofloxacin plus metronidazole; the rate of infection was 10.6% and 
cephalosporin plus metronidazole group was 14.6% while that in DNMC the 
rate were 8 and 10.6% respectively. The overall rate of infection was 11%. 

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in substantial morbidity and mortality. The combina-
tion of ciprofloxacin/metronidazole as well as several β
–lactum based regimens are among the commonly used 
regimens for the treatment of patients with such 
infections. The ciprofloxacin and metronidazole combi-
nation may be superior to β–lactum based therapeutic 
regimens in the treatment of intra-abdominal infections 
with regard to cure of infections although no difference 
in mortality was found (Mathaiou, 2006). 

The choice of an antibiotic depends on the expected 
spectrum of organisms likely to be encountered, the 
cost and local hospital policies, which are based on 
experience of local resistance trends (Koch, 2004) 

 

Materials and Methods 

In this study, 300 patients of two teaching hospitals 
(150 from Sir Salimullah Medical College and 150 from 
Dhaka National Medical College) were taken for 
interventional study. Once patients were selected for 
appendectomy or cholecystectomy either ciprofloxacin 
plus metronidazole or cephalosporin plus metronida-
zole were given intravenously. Age of the patients 
range from 25-40 years. The patients were then divided 
into four groups: Group I received drugs ciprofloxacin 
plus metronidazole in SSMC, Group II received drugs 
cephalosporin plus metronidazole in SSMC, Group III 
received drugs ciprofloxacin plus metronidazole in 
DNMC and Group IV received drugs cephalosporin 
plus metronidazole in DNMC. After surgery each 
patient was visited to check any sign of infection till 
discharge. 

Information regarding antimicrobials prescribed, name 
of antibiotics, duration of antimicrobial therapy, indica-
tions for which patients underwent surgery and 
incidence of post-operative infection were recorded in a 
data collection form. Variable recorded in the study 
were age of the patient, gender, monthly income, 
diagnosis, duration of hospital stay and occurrence of 
infection. All analysis was done using the statistical 
package for social science (SPSS) software for windows. 
To compare the differences between groups, Chi-
square tests were performed. 
 

Results 

There were 33 cases of infection out of total 300 study 
subjects.  

Among the study subjects, the rate of infection in 
Group I (received ciprofloxacin plus metronidazole in 
SSMC), Group II (received cephalosporin plus metro-
nidazole in SSMC), Group III (received ciprofloxacin 
plus metronidazole in DNMC) and Group IV (received 
cephalosporin plus metronidazole in DNMC) were 8 

(10.6%), 11 (14.6%), 6 (8%), 8 (10.6%) respectively (Table 
I). 

The overall rate of infection is 11%. But the rate of 
infection is relatively higher in SSMC than DNMC.  

 

Discussion 

Appendicitis and cholecystitis are more common 
diseases in our country. For treatment of these diseases 
surgical intervention is usually required. 
Cephalosporin, ciprofloxacin, metronidazole are used 
as surgical prophylaxis in the hospitals. In this study 
data was taken from cephalosporin plus metronidazole 
group and ciprofloxacin plus metronidazole group as 
abdominal surgical prophylaxis. There were 300 
subjects who were divided in four groups in two 
hospitals. 

Now-a-days ciprofloxacin-metronidazole and cephalos-
porin-metronidazole combination are chosen by sur-
geon to prevent wound infection following major 
abdominal surgical procedures. 

In the present study the overall rate of infection is 11% 
which seemed to be relatively higher compared to 
other studies. However, in one study carried out in 
SSMC, rate of infection was 8% where abdominal 
hysterectomy was performed in a group of middle 
aged patients (Rahman, 2005). This figure is closely 
similar to the present finding. 

In SSMC, the rate of infection is relatively higher than 
DNMC because of less cleanliness and presence of 
more attendants in the ward. In DNMC, the ward was 
almost clean and attendants of the patient were low. 

Low infection rates in clean cases are best obtained by 
strict adherence to the principles of good surgical 
technique. Other factors which help to keep the infec-
tion rate at a minimum include – a short pre-operative 

 Bangladesh J Pharmacol 2008; 3: 80-82   81 

Table I 

Proportion of subjects had wound infection in the 
study subjects  

Group   

No infection 
n (%) 

Infection 
n (%) 

I 67 
(89.3) 

8 
(10.6) 

II 64 
(85.3) 

11 
(14.6) 

III 69 
(92.0) 

6 
(8.0) 

IV 67 
(89.3) 

8 
(10.6) 

Outcome   



 

 

stay in the hospital, avoidance of shaving just prior to 
operation and pre-operative bathing with an antiseptic 
soap, moreover the cleanliness of the post-operative 
room (Nichols, 1981). 

The infection rate could be reduced if sterilization 
procedure of the operation theater and general condi-
tion of the patients were improved. If these risk factors 
could be minimized, single dose prophylactic antibio-
tic can be effectively practiced in our country. 

 

Conclusion 

The prophylactic antibiotic will be effective in redu-
cing post-operative infection if the proper drug is 
chosen.  

 

References 
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short practice of surgery. Russell RCG, Williams NS, 
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Kaiser AB. Antimicrobial prophylaxis in surgery. Medical 
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Chambers HF. Beta-lactam and other cell wall- and 

membrane-active antibiotics. In: Basic and clinical 
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Martin TC, Anthony F. Antibiotic use and overuse for appen-
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Mathaiou DK, Peppas G, Bliziotis I, Falagas ME. Ciprofloxa-
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Nichols RL. Use of prophylactic antibiotics in surgical 
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Rahman Z. Pattern of use of prophylactic antimicrobial in 
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& MH. Dhaka, MPhil Thesis, 2005. 

Relman AS, Angell M, Selzman EW. Post-operative wound 
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82 Bangladesh J Pharmacol 2008; 3: 80-82  

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Shusmita Saha (3ULQFLSDO�FRQWDFW� 
 

 


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