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Ampicillin-Sulbactam vs Clindamycin in Head and Neck Oncologic Surgery 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. doi:10.1001/archotol.1992.01880110027007.
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• 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)


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