COMPARISON OF EFFECT OF CEFTRIAXONE IN-FILTRATION BEFORE INCISION AND BEFORE CLOSURE IN LAPAROTOMY FOR PERFORATION PERITONITIS –A RANDOMIZED CONTROL STUDY.

Surgical site infection (SSI) continues to be a baffling problem. It is one of the major causes for postoperative morbidity and mortality. Over the years, reasonable success has been achieved in this direction by taking various aseptic measures, which were initiated by Joseph Lister  in 1860.

1 Initially, the antibiotics were only administered post-operatively for treatment of already established surgical site infection.

2 Later, the concept of antibiotic prophylaxis was introduced. After administration of intravenous (IV) antibiotic, there is distribution of antibiotics, initially in the systemic pool and then in the peripheral pool, which results in a low concentration of the antibiotic at the site where it is needed the most.

3 Therefore, the search for alternative modes of administration of prophylactic antibiotics was started so as to affect a further decrease in the rate of woundinfection. One such method is the intra-incisional infiltration of prophylactic antibiotics. This mode ensures a high concentration of antibiotic at the incision site and it has been proven to provide systemic cover by the absorption of the antibiotic from the incision site. Ceftriaxone an antibiotic with long half-life, was chosen because of its known effectiveness against a wide range of wound pathogens, including obligate anaerobes, at concentrations likely to be present locally. This study is done to evaluate the role of intra incisional infiltration of ceftriaxone in prevention of SSI.