Abstract
Background : In clean-contaminated operations such as breast surgery, antimicrobial agents are administered to prevent surgical site infection (SSI), caused mainly by Gram-positive cocci. It is considered that a single preoperative administration of penicillin or first-generation cephalosporin antibiotics within 30 minutes before the start of operations is effective for prevention of SSI. Azithromycin (AZM), an antimicrobial agent targeting Gram-positive cocci, might be available for prophylactic use in breast surgery.
Purpose : The aim of this study was to investigate the clinical effects of azithromycin administered as prophylaxis against postoperative infection in breast surgery.
Patients and methods : Thirty-nine patients who underwent breast surgery were enrolled in this study. All patients were randomly assigned to receive a single oral administration of AZM (2g/day) or intravenous antimicrobial injection of cefazorin (CEZ). The risk of SSI occurrence is considered equal in the groups, without regard to differences in the operation methods, because breast surgery is categorized as a clean operation in the CDC guidelines.
Results : The incidence of SSI in breast surgery was 0% in both groups. Adverse events of administered drugs consisted of 3 cases of diarrhea and one case of elevation of transaminase in the AZM group, and one case of elevation of transaminase in the CEZ group. All patients with adverse events were mildly symptomatic and recovered without further treatment. Measurement of AZM concentration revealed that all patients in the AZM group exceeded the minimum inhibitory concentration (MIC) against Methicillin-susceptible Staphylococcus aureus (MSSA) or Staphylococcus epidermidis.
Conclusions : Our results confirmed that AZM is effective for prevention of SSI in breast surgery.
