Antibiotic prophylaxis in pulmonary surgery: a double-blind study of penicillin versus placebo

A prospective, randomized double-blind study comparing high-dose short-term penicillin-G prophylaxis with placebo was conducted on patients referred for elective pulmonary surgery. The major advantages of penicillin prophylaxis over placebo were observed for wound infections (2/45 vs 9/47, respectively, p = 0.03), postoperative antibiotic use (13/45 vs 23/47, respectively, p = 0.049), and postoperative hospital stay (median 10 days vs 13 days, respectively, p = 0.02). The prophylactic penicillin regimen had no effect on the incidence of empyema or lower respiratory tract infections. Staphylococcus aureus and Haemophilus were identified as the major pathogens in post-operative infections. Penicillin significantly reduced the incidence of S. aureus in spite of resistance to penicillin in most isolated strains, while the frequency of Haemophilus was similar in the two treatment groups. Colonization with Enterobacteriaceae and Pseudomonas aeruginosa was pronounced in the penicillin group. Few side-effects of penicillin treatment were recorded. Short-term penicillin prophylaxis is recommended, but the ideal prophylactic regimen in pulmonary surgery has not yet been found.