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rate of infection in the postoperative period compared with the cephalothin group (10% vs. 27%). They further demon- strated that the difference was caused by significantly more anaerobic infections in the cephalothin group (21%) com- pared with the clindamycin group (2%). These two studies demonstrated a significantly lower rate of infection when antibiotics providing aerobic and anaerobic coverage are administered before operative treatment. Pro- phylactic antibiotics for patients sustaining penetrating ab- dominal injuries with intestinal contamination have a role for reducing the rate of incisional wound infection subjected to gastrointestinal soiling. A single dose providing sufficient concentration within the wound during the vulnerable period is optimal. The other aspect of prophylactic antibiotic admin- istration in trauma is the potential therapeutic role. The prob- lem is to define the time period when contamination of the abdominal cavity becomes an established infection. At celiot- omy, the intestinal wound is closed, eliminating further con- tamination and soiling of the peritoneal cavity. Thus, no further antibiotic should be necessary. Surgeons have concluded that "prophylactic antibiotics" in penetrating abdominal trauma can reduce the incidence of postoperative infectious complications. Since the mid-1970s, no study has included a placebo control group because of the high incidence of infectious complications after intestinal injury. However, many studies in the past 2 decades have compared various antibiotic regimens to evaluate single agents versus combination regimens, duration of administra- tion, and, more recently, the pharmacokinetics and cost im- plications of single versus combination therapy.

Practice Management Guidelines for Prophylactic Antibiotic Use in Penetrating Abdominal Trauma: The EAST Practice Management Guidelines Work Group