Bradycardia: antibiotics had no clear effect on infection by pacing catheters.

Clinical bottom line (level 2b-)

  1. Patients with a pacing catheter who were given antibiotic prophylaxis, had no clear difference in infection than those not given antibiotics.
Patton et al: New England Journal of Medicine 1966; 281: 1106-1108
Expires August 2003

The study

?blinded ?concealed quasi-randomised trial with intention-to-treat
Setting: general hospital, USA

43 patients (aged mean 65 years, all patients who received pacing catheters for second or third degree heart block, diagnosis or suppression of arrhythmia or the presence of significant conduction disturbance accompanying acute myocardial infarction

Excluded if
  • pacing catheter in place for less than 2 days


    • Note:
  • Patients alternately allocated to antibiotic or control groups.


    • Control Group: (n = 21, 21 analysed): no systemic antibiotic prophylaxis
    Experimental Group: (n = 22, 22 analysed): methicillin 1 mg intravenously or intramuscularly every 6 hours for 48 hours and then received 500 mg of dicloxacillin orally every 6 hours until the catheter was removed
    Catheters were inserted via the external jugular or antecubital veins under electrocardiographic and fluoroscopic control (or both). Site of insertion was prepared with benzalkonium before insertion. Bacitracin ointment was liberally applied to the site of infection after each daily change of dressing.
    100% followed for ?

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    local phlebitis unknown 4
    (19.1%)    		 3
    (13.6%)    		 28.0%
    (-182% to 82.0%)    		 5.41%
    (-16.7% to 27.5%)    		 18
    (NNT = 4.00 to infinity;
    NNH = 6 to infinity)

    Comments

    1. The study was far too small to show any difference in infections between the two groups.

    Citation

    1. Patton RD, Kenamore B, Stein E: Antibiotic prophylaxis for temporary transvenous pacemakers. New England Journal of Medicine 1966; 281: 1106-1108
    Contributor: Clare Wotton and Bob Phillips, August 1999
    Reviewer:

    Clinical Question.
    Patient heart block
    Intervention or Exposure antibiotics
    Comparison no antibiotics
    Outcome infection