Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2019 Dec 12;12(12):CD007370.
doi: 10.1002/14651858.CD007370.pub4.

Prophylactic antibiotics for penetrating abdominal trauma

Martin Brand  1 , Andrew Grieve  2
Affiliations
Meta-Analysis

Prophylactic antibiotics for penetrating abdominal trauma

Martin Brand et al. Cochrane Database Syst Rev. .

Abstract

Background: Penetrating abdominal trauma occurs when the peritoneal cavity is breached. Routine laparotomy for penetrating abdominal injuries began in the 1800s, with antibiotics first being used in World War II to combat septic complications associated with these injuries. This practice was marked with a reduction in sepsis-related mortality and morbidity. Whether prophylactic antibiotics are required in the prevention of infective complications following penetrating abdominal trauma is controversial, however, as no randomised placebo controlled trials have been published to date. There has also been debate about the timing of antibiotic prophylaxis. In 1972 Fullen noted a 7% to 11% post-surgical infection rate with pre-operative antibiotics, a 33% to 57% infection rate with intra-operative antibiotic administration and 30% to 70% infection rate with only post-operative antibiotic administration. Current guidelines state there is sufficient class I evidence to support the use of a single pre-operative broad spectrum antibiotic dose, with aerobic and anaerobic cover, and continuation (up to 24 hours) only in the event of a hollow viscus perforation found at exploratory laparotomy.

Objectives: To assess the benefits and harms of prophylactic antibiotics administered for penetrating abdominal injuries for the reduction of the incidence of septic complications, such as septicaemia, intra-abdominal abscesses and wound infections.

Search methods: Searches were not restricted by date, language or publication status. We searched the following electronic databases: the Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library 2019, issue 7 of 12), MEDLINE (OvidSP), Embase (OvidSP), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED), ISI Web of Science: Conference Proceedings Citation Index- Science (CPCI-S) and PubMed. Searches were last conducted on 23 July 2019.

Selection criteria: All randomised controlled trials of antibiotic prophylaxis in patients with penetrating abdominal trauma versus no antibiotics or placebo.

Data collection and analysis: Two authors screened the literature search results independently.

Main results: We identified no trials meeting the inclusion criteria.

Authors' conclusions: There is currently no information from randomised controlled trials to support or refute the use of antibiotics for patients with penetrating abdominal trauma.

PubMed Disclaimer

Conflict of interest statement

MAB: None known

ANG: None known

Figures

1
1
Study flow diagram.
See this image and copyright information in PMC

Update of

References

Additional references

Egger 1997
    1. Egger M, Davey SA, Schneider M, Minder C. Bias in a meta‐analysis detected by a simple, graphical test. BMJ (Clinical Research Edition) 1997;315(7109):629‐34. - PMC - PubMed
Fullen 1972
    1. Fullen WD, Hunt J, Altemeier WA. Prophylactic antibiotics in penetrating wounds of the abdomen. Journal of Trauma 1972;12(4):282‐9. - PubMed
Greenland 1985
    1. Greenland S, Robins J. Estimation of a common effect parameter from sparse follow‐up data. Biometrics 1985;41:55‐68. - PubMed
Handbook 2008
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008. Available from www.cochrane‐handbook.org.
Herrod 2019
    1. Herrod PJ, Boyd‐Carson H, Doleman B, Blackwell J, Williams JP, Bhalla A, et al. Prophylactic antibiotics for penetrating abdominal trauma: duration of use and antibiotic choice. Cochrane Database of Systematic Reviews 2019, Issue 12. [DOI: 10.1002/14651858.CD010808.pub2] - DOI - PMC - PubMed
Higgins 2002
    1. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta‐analysis. Statistics in Medicine 2002;21(11):1539‐58. - PubMed
Kjaergard 2001
    1. Kjaergard LL, Villumsen J, Gluud C. Reported methodological quality and discrepancies between large and small randomised trials in meta‐analyses. Annals of Internal Medicine 2001;135:982‐9. - PubMed
Luchette 2000
    1. Luchette FA, Borzotta AP, Croce MA, O'Neill PA, Whittmann DH, Mullins CD, et al. Practice management guidelines for prophylactic antibiotic use in penetrating abdominal trauma: the EAST Practice Management Guidelines Work Group. Journal of Trauma 2000;48(3):508‐18. - PubMed
Macaskill 2001
    1. Macaskill P, Walter SD, Irwig L. A comparison of methods to detect publication bias in a meta‐analysis. Statistics in Medicine 2001;20(4):641‐54. - PubMed
Mantel 1959
    1. Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. Journal of the National Cancer Institute 1959;22:719‐48. - PubMed
Moher 1998
    1. Moher D, Jadad AR, Moher M. Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta‐analyses?. Lancet 1998;352:609‐13. - PubMed
Poole 1944
    1. Poole LT. Army progress with penicillin. British Journal of Surgery 1944;32:110‐1.
Review Manager 2008 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.0 for Windows. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2008.
Schulz 1995
    1. Schulz KF, Chalmers I, Hayers RJ, Altman DG. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995;273:408‐12. - PubMed
Scott 1954
    1. Scott R. Care of the battle casualty in advance of the aid station. Walter Reed Army Medical Centre Conference on recent advances in medicine and surgery. 19 April 1954.
Thadepalli 1972
    1. Thadepalli H, Gorbach SL, Broido P, Norsen J. A prospective study of infections in penetrating abdominal trauma. American Journal of Clinical Nutrition 1972;25(12):1405‐8. - PubMed
Thadepalli 1973
    1. Thadepalli H, Gorbach SL, Broido PW, Norsen J, Nyhus L. Abdominal trauma, anaerobes, and antibiotics. Surgery, Gynecology and Obstetrics 1973;137(2):270‐6. - PubMed

MeSH terms

Substances

LinkOut - more resources