Prophylactic antibiotics in elective colorectal surgery

Abstract

A randomized prospective study was conducted on 194 patients who underwent elective colorectal surgery for carcinoma. All patients received the same mechanical bowel preparation. In addition, patients in group A received oral neomycin and erythromycin base; patients in group B received systemic metronidazole and gentamicin, while patients in group C received both oral and systemic antibiotics. Postoperative septic complications related to colorectal surgery occurred in 27.4 per cent, 11.9 per cent and 12.3 per cent respectively in groups A, B and C (chi 2 = 7; P less than 0.05). The incidence of sepsis in groups B and C was almost identical. Patients who received oral antibiotics alone (group A) had significantly higher risks of postoperative sepsis when compared with patients in either group B or group C (P less than 0.05). As there is no additional advantage of combining oral and systemic antibiotics, we recommend systemic metronidazole and gentamicin to be used with mechanical bowel preparation in elective colorectal surgery.

Meta‐analysis of oral antibiotics, in combination with preoperative intravenous antibiotics and mechanical bowel preparation the day before surgery, compared with intravenous antibiotics and mechanical bowel preparation alone to reduce surgical‐site infections in elective colorectal surgery

“…A further three studies were excluded as they were duplicate publications using cohorts already included in the meta‐analysis11, 12, 13. The remaining 22 studies were included in the review, of which 14 were RCTs14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, and eight were observational cohorts2 4, 28, 29, 30, 31, 32, 33 ( Table 1; Table   S1, supporting information). These studies included a total of 57 207 patients.…”

“…S1 (supporting information). Of the included RCTs, five14 16, 18 20, 22 were double‐blinded, three15 17, 23 were single‐blinded, and the remainder were unblinded. Most of the included cohort studies were at low risk of bias.…”

“…In the 14 RCTs14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, involving 3014 patients, rates of SSI in patients given preoperative oral antibiotic prophylaxis, in combination with i.v. antibiotic prophylaxis and MBP, were compared with those in patients who received only i.v.…”

“…Seven RCTs14 16, 17, 18 20, 21 24, involving 1141 patients, examined rates of SSI in patients given a preoperative oral combination of an oral aminoglycoside (kanamycin or neomycin) and erythromycin, along with i.v. antibiotic prophylaxis and MBP, in comparison with patients who received only i.v.…”

“…Six RCTs17 18, 21 22, 26 27, involving 1417 patients, examined rates of anastomotic leak in patients undergoing colorectal surgery who were given preoperative oral antibiotic prophylaxis, in combination with i.v. antibiotic prophylaxis and MBP, and in those who received only i.v.…”