amoxicillin-potassium-clavulanate-combination and Head-and-Neck-Neoplasms

Platinum-based chemoradiotherapy for locally advanced head and neck cancer (LAHNC) induces a high rate of acute toxicity, including dysphagia and aspiration pneumonia. We hypothesised that prophylactic antibiotics can prevent pneumonia and hospitalisations and can be cost-effective.. In this multicentre randomised trial, patients with LAHNC treated with chemoradiotherapy received prophylactic amoxicillin/clavulanic acid from day 29 after the start of treatment until 14 days after completion of chemoradiotherapy or standard care without prophylaxis. The primary objective was to observe a reduction in pneumonias. Secondary objectives were to evaluate the hospitalisation rate, adverse events, costs and health-related quality of life.. One hundred six patients were included; of which, 95 were randomised: 48 patients were allocated to the standard group and 47 patients to the prophylaxis group. A pneumonia during chemoradiotherapy and follow-up until 3.5 months was observed in 22 (45.8%) of 48 patients in the standard group and in 22 (46.8%) of 47 patients in the prophylaxis group (p = 0.54). Hospitalisation rate was significantly higher in the standard group versus the prophylaxis group, 19 of 48 pts (39.6%) versus 9 of 47 pts (19.1%), respectively (p = 0.03). Significantly more episodes with fever of any grade were observed in the standard group (29.2% vs 10.2%, p = 0.028). A significant difference in costs was found, with an average reduction of €1425 per patient in favour of the prophylaxis group.. Although prophylactic antibiotics during chemoradiotherapy for patients with LAHNC did not reduce the incidence of pneumonias, it did reduce hospitalisation rates and episodes with fever significantly and consequently tended to be cost-effective.

Topics: Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antibiotic Prophylaxis; Antineoplastic Agents; Carcinoma; Chemoradiotherapy; Cisplatin; Cost-Benefit Analysis; Deglutition Disorders; Female; Head and Neck Neoplasms; Health Care Costs; Hospitalization; Humans; Male; Middle Aged; Mortality; Mucositis; Pneumonia; Quality of Life; Radiotherapy, Intensity-Modulated; Young Adult

Perioperative antibiotic prophylaxis has significantly reduced wound infection rates in clean-contaminated head and neck surgical procedures but controversy still remains regarding the optimal antibiotic regime.. To examine the efficacy of different antibiotics in head and neck oncological surgery prophylaxis.. In this prospective, double-blind clinical trial, 189 patients with carcinoma of the upper aerodigestive tract were randomized to receive amoxicillin-clavulanate or cefazolin intravenously up to 1h before surgery and at 8-h intervals for an additional three doses.. An overall wound infection rate of 22% was observed. The infection rate in patients receiving cefazolin was 24% (22/92) vs. 21% (20/97) in those receiving amoxicillin-clavulanate; the difference was not statistically significant. Postoperative overall non-wound infection developed in 12% (22/189) patients; the rate of infection was 9.8% (9/92) in patients receiving cefazolin vs. 13.4% (13/97) in those receiving amoxicillin-clavulanate, without a statistically significant difference between the two groups. Gram-negative bacteria were more often isolated with Pseudomonas aeruginosa as the dominant species. The risk of postoperative infection was more influenced by the type of surgical procedure than by disease stage.. In clean-contaminated head and neck oncologic surgery amoxicillin-clavulanate prophylaxis was at least as efficient as cefazolin. However, when taking into account the fact that beta-lactamase containing strains have recently been spreading, amoxicillin-clavulanate should be the logical first choice.

Topics: Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Bronchitis; Carcinoma, Squamous Cell; Cefazolin; Double-Blind Method; Head and Neck Neoplasms; Humans; Injections, Intravenous; Laryngeal Neoplasms; Mouth Neoplasms; Pharyngeal Neoplasms; Pneumonia, Bacterial; Postoperative Complications; Prospective Studies; Pseudomonas aeruginosa; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections; Surgical Wound Infection; Tracheitis

Although appropriate perioperative antibiotic prophylaxis has significantly reduced wound infection rates in clean-contaminated head and neck surgical procedures, controversy still remains regarding the optimal antibiotic regimen.. In this prospective, double-blind clinical trial, 159 patients were randomized to receive amoxicillin-clavulanate, clindamycin plus gentamicin, or cefazolin intravenously up to 1/2 hour before surgery and at 6-hour intervals for an additional three doses.. An overall wound infection rate of 23% was observed. Thirteen (22.8%) infections occurred in the amoxicillin-clavulanate-treated group, 11 (21.2%) in the clindamycin plus gentamicin-treated group, and 13 (26%) in the cefazolin-treated group, which was not statistically significant. Only prior medical illnesses, such as chronic obstructive pulmonary disease and diabetes mellitus, correlated with an increased wound infection rate (p = 0.018).. Amoxicillin-clavulanate, clindamycin plus gentamicin, and cefazolin seem to have similar efficacy when administered prophylactically in clean-contaminated head and neck surgical procedures.

Topics: Adult; Aged; Aged, 80 and over; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Cefazolin; Chi-Square Distribution; Clavulanic Acids; Clindamycin; Double-Blind Method; Drug Therapy, Combination; Female; Gentamicins; Head and Neck Neoplasms; Humans; Injections, Intravenous; Laryngectomy; Length of Stay; Male; Middle Aged; Neoplasm Staging; Prospective Studies; Risk Factors; Surgical Flaps; Surgical Wound Infection; Treatment Outcome

Wound infections are a significant complication following major oncological head and neck surgery. In view of the controversy surrounding the use of chemoprophylaxis a controlled trial was designed. Intravenous Augmentin (amoxycillin and clavulanic acid) was shown to reduce significantly (P less than 0.025) the incidence of postoperative sepsis.

Topics: Adult; Aged; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Clavulanic Acids; Drug Combinations; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Premedication; Surgical Wound Infection

Infection after head and neck oncological surgery is relatively frequent, and is associated with significant morbidity and mortality.. The primary objective of this prospective study was to determine risk factors for Surgical Site Infection (SSI) in major head and neck cancer surgery.. A population of 137 head and neck cancer patients, of the Portuguese Institute of Oncology Francisco Gentil (Lisbon, Portugal), was prospectively studied in order to ascertain the correlation between 31 known risk factors and the presence of SSI.. The rate of SSI was 10.9%, with all of the infections being of the deep incisional type. A discriminant analysis and multiple logistic regression methods identified pre-surgical tracheostomy (p < 0.001), previous surgery (p = 0.001) and length of pre-operative hospital stay (p < 0.001) as the most significant risk factors for surgical site infections.. In order to minimize the risk of post-operative SSI in the context of head and neck cancer patients, particular attention should be paid to patients submitted to tracheostomy before surgery, to those submitted to previous oncological surgery, and to patients who are forced to remain in the hospital for prolonged periods of time before surgery.

Topics: Adult; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Debridement; Disinfection; Drainage; Female; Forecasting; Head and Neck Neoplasms; Humans; Length of Stay; Male; Middle Aged; Neoadjuvant Therapy; Povidone-Iodine; Preoperative Care; Prospective Studies; Reoperation; Risk Factors; Staphylococcal Infections; Surgical Wound Infection; Tracheostomy

In order to specify the correlation between pharyngeal flora and the onset of surgical wound infection, we conducted two prospective studies on patients undergoing oncologic surgical procedures with expected contamination by pharyngeal secretions. In the first study, an oropharyngeal swab and a specific swab of the tumour were collected the day before, or on the day of surgery. As potential pathogens were always isolated in the oropharyngeal swab, it was considered that the tumour is not infected but is colonised by the oropharyngeal flora. A second pharyngeal swab was collected at day 5-7 in the second study. Preliminary results in the second study showed that 50% (11/22) of patients were orpharyngeal carriers of pathogens before surgery. This rate is 70% (15/22) in the post-operative period with a higher rate of gram negative rods. WSI occurred in 7/22 patients (32%), mainly with isolated rods similar to those observed in the oropharyngeal post-operative flora and potential pathogens in 5/7 patients. More patients are necessary to establish a link between pre-operative ropharyngeal pathogens and the occurrence of SWI.

Topics: Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Clindamycin; Gentamicins; Head and Neck Neoplasms; Humans; Oropharynx; Prospective Studies; Surgical Wound Infection

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Cefuroxime; Cephalosporins; Clavulanic Acids; Drug Therapy, Combination; Head and Neck Neoplasms; Humans; Premedication; Surgical Wound Infection