***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective Patients who need major head and neck surgery like laryngectomy are at risk of postoperative wound infection . Although the role of antibiotics in prophylaxis of clean contaminated head and neck surgery has been well documented , controversy exists in the optimal antibiotic regimen . Methods In two tertiary referral hospitals ( Imam Khomeini and Amir Alam hospital ) , 90 patients undergoing laryngectomy  were prospect ively r and omized into two groups receiving cefazolin perioperative prophylaxis either for 2 days or for 5 days from June 2004 to March 2006 . Then patients were blindly examined for the development of wound infection . Results No wound infection was detected in either group . Two ( 4.4 % ) mucocutaneous fistula occurred in the 2-day group , and 3 ( 6.7 % ) in the 5-day group . There was no statistically significant difference in the infection rate between two groups . Conclusion We conclude that a 2-day perioperative cefazolin prophylaxis is equally effective as longer therapies . The increased morbidity and cost of the latter are in favor of the 2-day prophylactic regimen A total of 99 patients with head and neck cancer who were to undergo surgery were r and omized in a prospect i ve comparative study of sulbactam-ampicillin ( 1:2 ratio ; four doses of 3 g of ampicillin and 1.5 g of sulbactam intravenously [ i.v . ] every 6 h ) versus clindamycin ( four doses of 600 mg i.v . every 6 h)-amikacin ( two doses of 500 mg i.v . every 12 h ) as prophylaxis starting at the induction of anesthesia . The two groups of evaluable patients ( 43 in the clindamycin-amikacin treatment group and 42 in the sulbactam-ampicillin treatment group ) were comparable as far as age ( mean , 57 years ; range , 21 to 84 years ) , sex ratio ( 71 males , 28 females ) , weight ( mean , 66 kg ; range , 40 to 69 kg ) , indication for surgery ( first surgery , 48 patients ; recurrence , 37 patients ) , previous anticancer treatment ( surgery , radiation therapy , chemotherapy ) , type of surgery , and stage of cancer . The overall infection rate ( wound , bacteremia , and bronchopneumonia ) within 20 days after surgery was 20 patients in each group . Wound infections occurred in 14 ( 33 % ) sulbactam-ampicillin-treated patients and 9 ( 21 % ) clindamycin-amikacin-treated patients ( P = 0.19 ; not significant ) . The rates of bacteremia were 2 and 4 % , respectively . The rates of bronchopneumonia were 14.3 and 23.2 % , respectively ( P was not significant ) . Most infections were polymicrobial , but strict anaerobes were recovered only from patients who received sulbactam-ampicillin .  Antimicrobial treatment  was required within 20 days after surgery for 42 % of the sulbactam-ampicillin-treated patients and 44 % of the clindamycin-amikacin-treated patients . By comparison with previous studies , we observed a decreased efficacy of antimicrobial prophylaxis in patients with head and neck cancer undergoing surgery because of the increased proportion of patients who were at very high risk for infection ( extensive excision and plastic reconstruction in patients with recurrent stage III and IV cancers ) and because of the longer duration of surgery 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 design ed . Intravenous Augmentin ( amoxycillin and clavulanic acid ) was shown to reduce significantly ( P < 0.025 ) the incidence of postoperative sepsis OBJECTIVES The adequate perioperative antibiotic prophylaxis in head and neck cancer surgery is an important and easy applicable tool to decrease nosocomial morbidity and mortality by reducing the rate of infections . In the study a strictly perioperative antibiosis is compared with an extended postoperative prophylactic antibiosis . We aim to clarify the value of postoperative prophylactic antibiosis for the recovery and clinical course of patients . MATERIAL AND METHODS In this prospect i ve study 75 consecutive patients , who underwent major oncological head and neck surgery were included and divided in three groups , each containing 25 patients . The first group received peri- and postoperative antibiotic prophylaxis ( POAP ) from the day of operation until the fifth day postoperatively . The second group was treated with perioperative antibiotic prophylaxis ( PEAP ) only . The third group received perioperative antibiotic prophylaxis and increased local antiseptic care ( PAPAC ) . General anamnestic data was collected , as well as duration of hospitalisation , stay on intensive care unit , rate and type of infections , surgical closure of the tracheostomy , and postoperative blood parameters . RESULTS There were no statistically significant differences in general diseases or extent of surgery between the groups . There were statistically significant fewer patients suffering from surgical site infections in subjects with POAP ( n = 1 ) in comparison to PEAP ( n = 9 ; p = 0.011 ) and PAPAC ( n = 9 ; p = 0.011 ) . In contrast , other nosocomial infections ( pneumonia , urinary tract infection , sepsis ) did not decrease under a prolonged antibiotic prophylaxis . CONCLUSION Based on findings of the study , we recommend an extended postoperative antibiotic prophylaxis for patients undergoing major oncological head and neck surgery BACKGROUND Patients requiring major oncologic head and neck surgery are at high risk for postoperative wound infection when the surgical site is contaminated by secretions from the upper aerodigestive tract . Studies to identify agents active in the prevention of postoperative wound infection may serve to reduce patient morbidity . METHODS Patients scheduled for a major contaminated head and neck surgical procedure were r and omly assigned to receive either ampicillin/sulbactam or clindamycin . Medication was administered 1 to 2 hours prior to surgery and every 6 hours , for a total of five doses . Postoperatively , patients were followed daily for the development of wound infection or other septic complication . RESULTS A total of 242 patients were enrolled in the study ; 119 received ampicillin/sulbactam , and 123 received clindamycin .  A total of 169 patients were considered evaluable . Of the evaluable patients , 14 % in each group developed a postoperative wound infection . There were no statistically significant differences between the number of days to onset of wound infection , nor was there a statistically significant difference in the rate of non-wound infections in the two groups . There were no statistically significant differences between the intent to treat group and the evaluable group of patients . CONCLUSION It is concluded that ampicillin/sulbactam is as safe and effective as clindamycin in preventing postoperative wound infection following major head and neck surgery Patients who undergo major contaminated surgery of the head and neck benefit from perioperative antibiotic prophylaxis . This study was developed to determine if 5 days of antibiotic administration would be more effective than 1 day . A multi-institutional prospect i ve r and omized double-blind study was design ed . Patients who were identified as requiring pedicled flap reconstruction were potential c and i date s for the study . Later , patients were r and omly assigned to receive cefoperazone sodium for either 24 hours or 120 hours . In each case , the drug was administered intravenously , beginning 1 to 2 hours preoperatively and continued for the prescribed period . One hundred nine patients were evaluable . Fifty-three patients were assigned to 1 day of perioperative prophylaxis .  Wound Infection developed in ten patients ( 18.9 % ) . Fifty-six patients were assigned to 5 days of perioperative antibiotic prophylaxis .  Wound infection developed in 14 ( 25 % ) of these patients ( P > .05 ) . These data suggest that no beneficial effect from administration of antibiotics for longer than 24 hours postoperatively can be achieved in patients who undergo myocutaneous flap reconstruction A prospect i ve study in 53 eligible patients , undergoing major head and neck cancer surgery was carried out to assess the combination of an ureido penicillin , piperacillin with a nitro imidazole agent , ornidazole , in order to prevent post-operative general and wound infections . Both antibiotics were administered for five days . Each patient had piperacillin 4 gm every eight hours and ornidazole 1 gm every 24 hours . The overall rate of infections was 13.2 per cent ( n = 7 ) , with 3.8 per cent ( n = 2 ) wound infections and 11.3 per cent ( n = 6 ) general infections ( one patient presented both complications ) . There was no wound infection in the total surgery group ( n = 12 ) . General infections who only consisted of pneumonias were respectively 12.2 per cent ( n = 5 ) in the group with partial procedures ( n = 41 ) and 8.3 per cent ( n = 1 ) in the total surgery group . This antibioprophylaxis can be recommended in major oncological neck surgery , specially in the case of partial procedures BACKGROUND Twenty-four hours of perioperative antibiotics provides effective prophylaxis for most head and neck cancer resections . Many reconstructive surgeons have been hesitant to apply this st and ard to free-flap reconstruction of the head and neck . This prospect i ve clinical trial compared short-course and long-course clindamycin prophylaxis for wound infection in patients with head and neck cancer undergoing free-flap reconstruction . METHODS Seventy-four patients were r and omized to receive short-course ( 3 doses ) or long-course ( 15 doses ) clindamycin perioperatively . Wound infections , fistulas , and other postoperative complications were documented by faculty surgeons who were blinded as to treatment group . RESULTS The differences in wound infections and other complications were statistically insignificant . No other independent predictors of wound complications emerged in this series of patients . CONCLUSIONS Short-course clindamycin is as effective as long-course clindamycin in preventing wound infections after free-flap surgery for head and neck ablative defects BACKGROUND 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 . OBJECTIVE To examine the efficacy of different antibiotics in head and neck oncological surgery prophylaxis . PATIENTS AND METHODS In this prospect i ve , double-blind clinical trial , 189 patients with carcinoma of the upper aerodigestive tract were r and omized to receive amoxicillin-clavulanate or cefazolin intravenously up to 1h before surgery and at 8-h intervals for an additional three doses . RESULTS 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 . CONCLUSION 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 Previous studies of antibiotic prophylaxis have shown that treatment for 24 hours has been beneficial for head and neck surgery and that longer periods of antibiotic therapy have not improved results . Metronidazole ( Flagyl ) , unlike other antibiotics tested , has been shown to be effective in an experimental abscess , even if treatment is begun up to 120 hours after administration of inoculum . This article presents a prospect i ve , r and omized , multifactorial study comparing a brief vs. a prolonged duration of metronidazole and cefazolin prophylaxis in 50 consecutive patients with a head and neck cancer undergoing operation . Patients receiving 2 days vs. 7 or more days of antibiotic prophylaxis were compared . Statistical analysis of data demonstrated a striking reduction in severity of wound complications and a reduced incidence of wound infections in the group treated with 7 or more days of antibiotic prophylaxis 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 The rationale for use of peri 
    Output:
    
Compared with placebo , cefazolin , ampicillin – sulbactam , and amoxicillin – clavulanate were the most efficient agents .
Benzylpenicillin and clindamycin were clearly less effective .
In clean-contaminated head and neck surgery , cefazolin , amoxicillin – clavulanate , and ampicillin – sulbactam for 24–48 h after surgery were associated with the highest prevention rate of surgical site infection