Randomized Clinical Trial of Co-Amoxiclav Versus No Antibiotic Prophylaxis in Varicose Vein Surgery

Br J Surg. 2010 Jan;97(1):29-36. doi: 10.1002/bjs.6849.

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).

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Amoxicillin-Potassium Clavulanate Combination / therapeutic use*
  • Anti-Bacterial Agents / therapeutic use*
  • Antibiotic Prophylaxis / methods*
  • Asepsis / methods
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Middle Aged
  • Surgical Wound Infection / prevention & control*
  • Treatment Outcome
  • Varicose Veins / surgery*

Substances

  • Anti-Bacterial Agents
  • Amoxicillin-Potassium Clavulanate Combination

Associated data

  • ISRCTN/ISRCTN12467340