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


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.


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



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.


  1. 1.
    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 1–23Google Scholar
  2. 2.
    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, LondonGoogle Scholar
  3. 3.
    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 81:1673–1676Google Scholar
  4. 4.
    Burke P, Mealy K, Gillen P, Joyce W, Traynor O, Hyland J (1994) Requirement for bowel preparation in colorectal surgery. Br J Surg 81:907–910Google Scholar
  5. 5.
    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 237:363–367Google Scholar
  6. 6.
    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 46:1013–1020Google Scholar
  7. 7.
    Rombeau J, McClane S (1999) Perioperative care of the colorectal patient. Dis Colon Rectum 42:845–856Google Scholar
  8. 8.
    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 69:150–154Google Scholar
  9. 9.
    Nichols RL, Condon RE (1971) Preoperative preparation of the colon. Surg Gynecol Obstet 132:323–337Google Scholar
  10. 10.
    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 18:422–427Google Scholar
  11. 11.
    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 40:585–591Google Scholar
  12. 12.
    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 12:606–608Google Scholar
  13. 13.
    Wenzel RP (1993) Preoperative prophylactic antibiotics: brief historical note. Infect Control Hosp Epidemiol 14:121Google Scholar
  14. 14.
    Lee JT (1995) Surgical wound infections: surveillance for quality improvement. In: Fry DE (ed) Surgical infections. Little, Brown and Company, Boston, MassachusettsGoogle Scholar
  15. 15.
    DiPiro JT (1999) Short-term prophylaxis in clean–contaminated surgery. J Chemother 11:551–555Google Scholar
  16. 16.
    Song F, Glenny AM (1998) Antimicrobial prophylaxis in colorectal surgery: a systematic review of randomized controlled trials. Br J Surg 85:1232–1241Google Scholar
  17. 17.
    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 46:3026–3030Google Scholar
  18. 18.
    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 27:97–132Google Scholar
  19. 19.
    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 45:173–180Google Scholar
  20. 20.
    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 158:359–362Google Scholar
  21. 21.
    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 44:75–80Google Scholar
  22. 22.
    Kaiser AB, Herrington JL, Jacobs JK, Mulherin JL, Roach AC, Sawyers JL (1983) Cefoxitin versus erythromycin, neomycin, and cefazolin in colorectal operations. Ann Surg 198:525–530Google Scholar
  23. 23.
    Peruzzo L, Savio S, De Lalla F (1987) Systemic versus systemic plus oral chemoprophylaxis in elective colorectal surgery. Chemioterapia 6(Suppl 2):601–603Google Scholar
  24. 24.
    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 56:251–254Google Scholar
  25. 25.
    Coppa GF, Eng K (1988) Factors involved in antibiotic selection in elective colon and rectal surgery. Surgery 75:782–785Google Scholar

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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