Prospective, randomised study on antibiotic prophylaxis in colorectal surgery. Is it really necessary to use oral antibiotics?
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Background and aims
The use of prophylactic antibiotics in addition to mechanical cleansing is the current standard of care prior to colonic surgery. The question of whether the antibiotics should be administered intravenously or orally, or by both routes, remains controversial. Our aim was to compare three methods of prophylactic antibiotic administration in elective colorectal surgery.
Three hundred consecutive elective colorectal resections were studied. All patients had preoperative mechanical colon cleansing with oral sodium phosphate and intravenous antibiotic prophylaxis with cefoxitin (one dose before skin incision and two postoperative doses). Patients were randomised to one of the following three groups: group A: three doses of oral antibiotic (neomycin and metronidazole) at the time of mechanical colon cleansing; group B: one dose of oral antibiotic; group C: no oral antibiotics. All patients were followed during their hospital stay and at 7, 14 and 30 days post-surgery.
Vomiting occurred in 31%, 11% and 9% of the studied patients (groups A, B and C, respectively) (p<0.001). Nausea was present in 44%, 18% and 13% of patients (p<0.001). Abdominal pain was recorded in 13%, 10% and 4% of patients (p: 0.077). Wound infection was present in 7%, 8% and 6% and suture dehiscence occurred in 2%, 2% and 3% of the patients in the three groups (no differences among them). Neither were differences found among the three groups in terms of urinary infections, pneumonia, postoperative ileus or intra-abdominal abscess.
The addition of three doses of oral antibiotics to intravenous antibiotic prophylaxis is associated with lower patient tolerance in terms of increased nausea, vomiting and abdominal pain, and has shown no advantages in the prevention of postoperative septic complications. Therefore, we recommend that oral antibiotics should not be used prior to colorectal surgery.
- Singh JJ, Hamel CT, Wexner SD (2000) Evidence-based surgery: pre and postoperative care. In: Boulos PB, Wexner SD (eds) Challenges in colorectal surgery. WB Saunders, London, pp 1–23
- The Association of Coloproctology of Great Britain and Ireland (2001) Guidelines for the management of colorectal cancer. The Association of Coloproctology of Great Britain and Ireland, London
- Santos-Junior JC, Batista J, Sirimarco MT, Guimaraes AS, Levy CE (1994) Prospective randomized trial of mechanical bowel preparation in patients undergoing elective colorectal surgery. Br J Surg 81:1673–1676
- Burke P, Mealy K, Gillen P, Joyce W, Traynor O, Hyland J (1994) Requirement for bowel preparation in colorectal surgery. Br J Surg 81:907–910
- Zmora O, Mahajana A, Bar-Zakai B, Rosin D, Hershko D, Shabtai M, Krausz M, Ayalon A (2003) Colon and rectal surgery without mechanical bowel preparation. A randomized prospective trial. Ann Surg 237:363–367
- Wille-Jorgensen P, Guenaga K, Castro A, Matos D (2003) Clinical value of preoperative mechanical bowel cleansing in elective colorectal surgery: a systematic review. Dis Colon Rectum 46:1013–1020
- Rombeau J, McClane S (1999) Perioperative care of the colorectal patient. Dis Colon Rectum 42:845–856
- Zmora O, Wexner SD, Hajar L, Park T, Efron JE, Nogueras JJ, Weiss EG (2003) Trends in preparation for colorectal surgery: survey of the members of the American Society of Colon and Rectal Surgeons. Am Surg 69:150–154
- Nichols RL, Condon RE (1971) Preoperative preparation of the colon. Surg Gynecol Obstet 132:323–337
- Dellinger EP, Gross PA, Barrett TL, Krause PJ, Martone WJ, McGowan JE Jr, Sweet RL, Wenzel RP (1994) Quality standard for antimicrobial prophylaxis in surgical procedures. Infectious Diseases Society of America. Clin Infect Dis 18:422–427
- Oliveira L, Wexner SD, Daniel N, DeMarta D, Weiss EG, Nogueras JJ, Bernstein M (1997) Mechanical bowel preparation for elective colorectal surgery: a prospective, randomized, surgeon-blinded trial comparing sodium phosphate and polyethylene glycol-based oral lavage solutions. Dis Colon Rectum 40:585–591
- Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 12:606–608
- Wenzel RP (1993) Preoperative prophylactic antibiotics: brief historical note. Infect Control Hosp Epidemiol 14:121
- Lee JT (1995) Surgical wound infections: surveillance for quality improvement. In: Fry DE (ed) Surgical infections. Little, Brown and Company, Boston, Massachusetts
- DiPiro JT (1999) Short-term prophylaxis in clean–contaminated surgery. J Chemother 11:551–555
- Song F, Glenny AM (1998) Antimicrobial prophylaxis in colorectal surgery: a systematic review of randomized controlled trials. Br J Surg 85:1232–1241
- Zelenitsky SA, Ariano RE, Harding GK, Silverman RE (2002) Antibiotic pharmacodynamics in surgical prophylaxis: an association between intraoperative antibiotic concentrations and efficacy. Antimicrob Agents Chemother 46:3026–3030
- Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for prevention of surgical site infection. Centers for Disease Control and Prevention (CDC). Hospital Infection Control Practices Advisory Committee. Am J Infect Control 27:97–132
- Lewis RT (2002) Oral versus systemic antibiotic prophylaxis in elective colon surgery: a randomized study and meta-analysis send a message from the 1990s. J Can Chir 45:173–180
- Figueras-Felip J, Basilio-Bonet E, Lara-Eisman F, Coride-Garcia P, Isamat-Baro E, Fava-Bargallow P (1984) Oral is superior to systemic antibiotic prophylaxis in operations upon the colon and rectum. Surg Gynecol Obstet 158:359–362
- Yabata E, Okabe S, Endo M (1997) A prospective, randomized clinical trial of preoperative bowel preparation for elective colorectal surgery—comparison among oral, systemic, and intraoperative luminal antibacterial preparations. J Med Dent Sci 44:75–80
- Kaiser AB, Herrington JL, Jacobs JK, Mulherin JL, Roach AC, Sawyers JL (1983) Cefoxitin versus erythromycin, neomycin, and cefazolin in colorectal operations. Ann Surg 198:525–530
- Peruzzo L, Savio S, De Lalla F (1987) Systemic versus systemic plus oral chemoprophylaxis in elective colorectal surgery. Chemioterapia 6(Suppl 2):601–603
- Stellato TA, Danzinger LH, Gordon N, Hau T, Zollinger RM Jr, Shuck JM (1990) Antibiotics in elective colon surgery. A randomized trial of oral, systemic, and oral/systemic antibiotics for prophylaxis. Am Surg 56:251–254
- Coppa GF, Eng K (1988) Factors involved in antibiotic selection in elective colon and rectal surgery. Surgery 75:782–785
- Prospective, randomised study on antibiotic prophylaxis in colorectal surgery. Is it really necessary to use oral antibiotics?
International Journal of Colorectal Disease
Volume 20, Issue 6 , pp 542-546
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- Surgical wound infection—prevention and control
- Antibiotics—administration and dosage
- Postoperative complications—prevention and control
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- Author Affiliations
- 1. Department of General Surgery, Colorectal Surgery Unit, Hospital Valle de Hebron, Autonomous University of Barcelona, 4th Floor, Pg Valle de Hebron 119-129, Barcelona, 08035, Spain
- 2. Department of Preventive Medicine and Epidemiology, Hospital Valle de Hebron, Autonomous University of Barcelona, Barcelona, Spain