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Prophylactic regimens in colorectal surgery: An open, randomized, consecutive trial on metronidazole used alone or in combination with ampicillin or doxycycline

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Abstract

In 17 Scandinavian hospitals, an open, randomized, consecutive trial was made on the use of prophylactic antibiotics in colorectal surgery. Metronidazole used alone was compared with metronidazole supplemented by ampicillin or doxycycline. Each type of drug was given as a single preoperative intravenous infusion. With metronidazole alone, postoperative infection occurred in 12.9% of all patients. This figure was significantly reduced to 3.2% by adding ampicillin or doxycycline to the prophylactic regimen (p=0.01). The additional effect achieved by ampicillin or doxycycline was due to a significant reduction of wound infections in cases of rectal surgery. For operations on the right and left colon, no significant improvement was obtained by adding ampicillin or doxycycline to metronidazole (p=0.19). For no type of colorectal surgery was there any significant difference in infection rate between patients who received metronidazole plus ampicillin and those who were given the combination of metronidazole and doxycycline. It is concluded that ampicillin and doxycycline are equally effective. Ampicillin is recommended, however, due to the increasing selection of tetracycline-resistant bacteria. One single preoperative infusion of each drug gave the same effect as found in a previous study after multiple infusions, the first of them being given preoperatively. It is concluded that a satisfactory prophylactic effect is obtained by a single preoperative infusion of antimicrobial drugs directed against anaerobic as well as aerobic bacteria.

Résumé

Une étude randomisée de l'effet prophylactique des antibiotiques au cours de la chirurgie colorectale a été effectuée dans 17 hôpitaux Scandinaves. Le Metronidazole fut d'une part employé seul, d'autre part employé en association avec l'ampicilline ou la doxycycline. Chacun de ces agents antibactériens fut injecté par voie intraveineuse avant l'intervention. Quand le Metronidazole fut employé seul le taux de l'infection postopératoire s'éleva à 12.9%. Il s'abaissa à 3.2% en ajoutant à ce premier agent de l'ampicilline ou de la doxycycline. L'effet bénéfique de l'antibiothérapie associée se traduisit par une réduction significative de l'infection pariétale après chirurgie rectale alors qu'après chirurgie du colon droit ou du colon gauche l'association d'ampicilline ou de doxycycline au metronidazole ne fut suivie d'aucune amélioration significative. Il est à noter qu'aucune différence ne se manifesta selon que l'ampicilline ou la doxycycline fut employée. En fait leur efficacité est identique. L'ampicilline cependant mérite d'Être recommandée en raison de l'augmentation sélective de la résistance des bactéries à la tétracycline. Fait important les effets d'une injection intraveineuse unique sont identiques à ceux consécutifs à des injections répétées, dès lors qu'elle est pratiquée immédiatement avant l'intervention. On peut conclure de ces faits à l'efficacité de l'antibiothérapie prophylactique par injection unique intraveineuse préopératoire d'agents antibactériens agissant sur les bactéries anaérobies et les bactéries aérobies.

Resumen

Diez y siete hospitales escandinavos participaron en un estudio abierto, consecutivo, y aleatorizado sobre el uso profiláctico de antibióticos en cirugía colorrectal. Se comparé el metronidazol como agente Único, contra el metronidazol combinado con ampicilina o doxiciclina. Cada tipo de medicación fue administrado en una infusión intravenosa preoperatoria Única. Con el metronidazol como agente Único, se presentó infección postoperatoria en 12.9% de los pacientes. Esta tasa de infección se vió significativamente reducida a 3.2% al adicionar ampicilina o doxociclina al régimen preoperatorio (p=0.01). El efecto adicional obtenido con la ampicilina o doxiciclina se debió a una reducción significativa del nÚmero de infecciones de herida en los casos de cirugía rectal. En las operaciones del colon derecho o izquierdo, no se observó un efecto significativo al adicionar ampicilina o doxiciclina al metronidazol (p = 0.19). En ningÚn tipo de cirugía colorrectal se observó diferencia significativa en la reducción de la tasa de infección entre los pacientes que recibieron metronidazol más ampicilina y los que recibieron metronidazol más doxiciclina. La conclusión es que la ampicilina y la doxiciclina son igualmente efectivas. Sinembargo, se recomienda la ampicilina teniendo en cuenta la creciente selectividad de bacterias resistentes a la tetraciclina. Una infusión preoperatoria Única de cada droga ofreció el mismo efecto que fue observado en un estudio previo en que se usaron infusiones multiples, con la primera administrada preoperatoriamente. Hemos llegado a la conclusión de que se logra un satisfactorio efecto profiláctico con una infusión preoperatoria Única de drogas antimicrobianas que sean efectivas tanto contra las bacterias anaeróbicas como contra las aeróbicas.

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Correspondence to Magne Roland M.D., Ph.D..

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See list of participating researchers at the end of this report.

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Roland, M. Prophylactic regimens in colorectal surgery: An open, randomized, consecutive trial on metronidazole used alone or in combination with ampicillin or doxycycline. World J. Surg. 10, 1003–1008 (1986). https://doi.org/10.1007/BF01658658

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Keywords

  • Ampicillin
  • Metronidazole
  • Avant
  • Doxycycline
  • Como