Doxycycline and cefamandole prophylaxis for premenopausal women undergoing vaginal hysterectomy.

Fifty-one premenopausal women were given perioperative intravenous antimicrobial prophylaxis at vaginal hysterectomy in a prospective, blinded comparative study. Febrile morbidity developed in 14 women (27.4 per cent), but only nine (17.6 per cent) required antimicrobial treatment. The incidence of postoperative pelvic infection was 19.2 per cent for 26 women given 200 milligrams of doxycycline preoperatively and 16 per cent for 25 women given 5 grams of cefamandole in four doses over a period of 18 hours. Infections were polymicrobial, usually occurred during the initial hospitalization and significantly prolonged hospital stay (p less than 0.01). No variables were identified that allowed prediction of infection. A single dosage of doxycycline was as effective at preventing posthysterectomy pelvic infection as were multiple dosages of cefamandole.