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International Journal of Colorectal Disease

, Volume 20, Issue 6, pp 542–546 | Cite as

Prospective, randomised study on antibiotic prophylaxis in colorectal surgery. Is it really necessary to use oral antibiotics?

  • Eloy Espin-BasanyEmail author
  • Jose Luis Sanchez-Garcia
  • Manuel Lopez-Cano
  • Roberto Lozoya-Trujillo
  • Meritxell Medarde-Ferrer
  • Lluis Armadans-Gil
  • Laia Alemany-Vilches
  • Manuel Armengol-Carrasco
Original Article

Abstract

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

Antibiotic—prophylaxis Colon—surgery Surgical wound infection—prevention and control Antibiotics—administration and dosage Postoperative complications—prevention and control 

Notes

Acknowledgements

The authors thank Dr. Benito Almirante for his helpful advice in the technical revision of this manuscript and for his expertise in antibiotic prophylaxis. The authors are also grateful to Miss Christine O’Hara for her kind revision of the translation.

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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Eloy Espin-Basany
    • 1
    Email author
  • Jose Luis Sanchez-Garcia
    • 1
  • Manuel Lopez-Cano
    • 1
  • Roberto Lozoya-Trujillo
    • 1
  • Meritxell Medarde-Ferrer
    • 1
  • Lluis Armadans-Gil
    • 2
  • Laia Alemany-Vilches
    • 2
  • Manuel Armengol-Carrasco
    • 1
  1. 1.Department of General Surgery, Colorectal Surgery Unit, Hospital Valle de HebronAutonomous University of BarcelonaBarcelonaSpain
  2. 2.Department of Preventive Medicine and Epidemiology, Hospital Valle de HebronAutonomous University of BarcelonaBarcelonaSpain

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