Summary
Due to the high incidence of infective complications following colorectal surgery, prophylactic application of systemic antibiotics is required. In a prospective, randomised study of 34 patients who underwent elective colorectal surgery, it was found that a single 1 g dose of cefotaxime was as effective as three doses in controlling post-operative infections. Both groups received 500 mg metronidazole i.v. every 12 h for 72 h, with the first dose administered immediately prior to surgery. The results indicate that prophylactic cefotaxime and metronidazole are effective in reducing the incidence of septic complications following colorectal surgery; nevertheless, a study with a larger number of patients is needed to reach a definitive conclusion.
Zusammenfassung
Kolorektale Operationen sind durch eine hohe Inzidenz an infektiösen Komplikationen belastet; eine systemische Antibiotikaprophylaxe ist daher erforderlich. In einer prospektiven, randomisierten Studie wurden zwei Cefotaxim-Prophylaxeregime — die i.v. Gabe einer Einzeldosis von 1 g Cefotaxim bei gleichzeitiger Injektion von 500 mg Metronidazol kurz vor Beginn der Operation — und drei Einzelgaben von 1 g Cefotaxim — verglichen. In beiden Fällen wurde Metronidazol mit der ersten Dosis gegeben und in 12-stündlichen Abständen bis 72 Stunden postoperativ wiederholt. Die noch nicht abgeschlossene Studie umfaßt bisher 34 Patienten, bei denen ein elektiver kolorektaler Eingriff vorgenommen wurde. Das Prophylaxeregime mit Cefotaxim und Metronidazol erwies sich — sowohl bei der Einzel- wie der Dreifach-Dosierung von Cefotaxim — als wirksame Methode, infektiöse Komplikationen bei kolorektalen Eingriffen zu verhüten. Ein abschließendes Urteil ist erst mit einer umfangreichen Patientenzahl möglich.
Similar content being viewed by others
References
Wittmann, D. H., Quintiliani, R.: Prophylaxis in general surgery. Infect. Surg. (1983) 825–830.
Polacek, M. A., Sanfelipoo, P. Oral antibiotic bowel preparation and complications in colon surgery. Arch. Surg. 97 (1968) 412–417.
Herter, F. P., Slanetz, C. A. Influence of antibiotic preparation of the bowel in complications after colon resection. Amer. J. Surg. 113 (1967) 165–172.
Evans, M., Pollock, A. V. The inadequacy of published random control trials of antibacterial prophylaxis in colorectal surgery. Dis. Colon Rectum 30 (1987) 743–746.
Scott, P. B., Robert, C. B. Effects of prophylactic antibiotics on wound infection after elective colon and rectal surgery: 1960 to 1980. Amer. J. Surg. 145 (1983) 300–308.
Baum, M., Anish, D., Chalmers, T., Sacks, H., Smith Jr., H., Fagerstrom, R. A. Survey of clinical trials of antibiotic prophylaxis in colon surgery: evidence against use of no-treatment controls. N. Engl. J. Med. 305 (1981) 795–799.
Alexander, J. W., Sykes, N. S., Mitchell, B. S., Fisher, M. W. Concentration of selected intravenously administered antibiotics in experimental surgical wounds. J. Trauma 13 (1973) 422–434.
Brote, L., Gillquist, J., Hojer, H. Prophylactic cephalothin in gastrointestinal surgery. Acta Chir. Scand. 142 (1976) 238–245.
Higgins, A. E., Lewis, A., Noone, P. Single and multiple dose cotrimoxazole and metronidazole in colorectal surgeries. Br. J. Surg. 67 (1980) 90–92.
Polk, H. C., Lopez-Mayor, J. F. Post operative wound infection. A prospective study of determinate factors and prevention. Surgery 66 (1969) 97–103.
Hughes, E. S. R., McDermott, E. T., White, A., Masterton, J. P. Cephaloridine prophylaxis in resection of large intestine. Aust. N. Z. J. Surg. 49 (1979) 434–437.
Burdon, J. G. W., Morris, P. J., Hunt, P., Watts, J. A trial of cephalothin sodium in colon surgery to prevent wound infection. Surgery 112 (1977) 1169–1173.
Lewis, R. T., Allan, C. M., Goodall, R. G., Lloyd-Smith, W. C., Marien, B., Wiegard, F. Antibiotics in surgery of the colon. Can. J. Surg. 21 (1978) 339–341.
Slama, T. G., Carey, L. C., Fass, R. J. Comparative efficacy of prophylactic cephalothin and cefamandole for elective colon surgery. Results of a prospective, randomized, double-blind study. Am. J. Surg. 137 (1979) 593–596.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Rangabashyam, N., Rathnasami, A. Prophylaxis of infection following colorectal surgery. Infection 19, 459–461 (1991). https://doi.org/10.1007/BF01726466
Issue Date:
DOI: https://doi.org/10.1007/BF01726466