[Which antibiotics should one choose for prophylaxis in vascular surgery?]

Abstract

Although the principle and duration of prophylactic antibiotic therapy in prosthetic vascular surgery are fairly widely accepted, the choice of antibiotic is still open to discussion. During two successive periods, identical groups of patients received peri-operative prophylaxis with, during period I (455 cases) oxacillin alone and during period II (537 cases) combined treatment with oxacillin and amikacin. The aim of the study was to evaluate efficacy of the association and to draw general conclusions on choice of antibiotic. The addition of amikacin reduced frequency of infection in elective operations, particularly aorto-ilio-femoral prostheses (0.5% as against 1.24%), but not in operations conducted as emergencies. In addition, frequency of infection due to BGN fell only slightly. Finally, combined therapy with oxacillin-amikacin had 2 disadvantages: impossibility of using these antibiotics for prophylaxis alone as provided for in the protocol, and its high cost. Factors of choice of antibiotic should be: efficacy against germs encountered, which can vary from year to year, rarity of toxic or side effects, good tissue diffusion, the rare need for therapeutic use and a low cost.