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

Eloy Espin-Basany*, Jose Luis Sanchez-Garcia, Manuel Lopez-Cano, Roberto Lozoya-Trujillo, Meritxell Medarde-Ferrer, Lluis Armadans-Gil, Laia Alemany-Vilches, Manuel Armengol-Carrasco

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

58 Citations (Scopus)

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.

Original languageAmerican English
Pages (from-to)542-546
Number of pages5
JournalInternational Journal of Colorectal Disease
Volume20
Issue number6
DOIs
Publication statusPublished - Nov 2005

Keywords

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

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