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The Need for Gram-negative Coverage

Randal S. Weber, MD; Issam Raad, MD; Robert Frankenthaler, MD; Patti Hankins, RN; Robert M. Byers, MD; Oscar Guillamondegui, MD; Pat Wolf; Terry Smith, MS; Helmuth Goepfert, MD

Arch Otolaryngol Head Neck Surg. 1992;118(11):1159-1163.

Abstract
• This study was undertaken to assess whether gram-negative antimicrobial coverage is required in patients undergoing head and neck oncologic surgery. Ampicillin sodium–sulbactam sodium and clindamycin phosphate were compared in a prospective, randomized, parallel, double-blind trial of 212 patients undergoing head and neck procedures involving clean-contaminated wounds. Both antibiotics were given up to 1 hour before surgery and continued at 6-hour intervals after surgery for an additional eight doses. Fourteen infections occurred in the ampicillin-sulbactam–treated group (13.3%) and 29 infections in the clindamycin-treated group (27.1%). From patients receiving clindamycin, 29 gram-negative organisms were isolated, compared with six from those patients receiving ampicillin-sulbactam. This finding supports the need for gram-negative coverage in patients undergoing clean-contaminated head and neck oncologic surgery.

(Arch Otolaryngol Head Neck Surg. 1992;118:1159-1163)

Author Affiliations
From the Department of Head and Neck Surgery (Drs Weber, Frankenthaler, Byers, Guillamondegui, and Goepfert and Mss Hankins and Wolf), Department of Medical Specialties, Section of Infectious Diseases (Dr Raad), and Department of Biomathematics (Ms Smith), University of Texas M. D. Anderson Cancer Center, Houston.

Footnotes
Accepted for publication May 6, 1992.

Reprint requests to Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (Dr Weber).

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