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

Espín‐Basany, Eloy; Sánchez-García, José Luis; López-Cano, Manuel; Lozoya-Trujillo, Roberto; Medarde-Ferrer, Meritxell; Armadans-Gil, Lluı́s; Alemany-Vilches, Laia; Armengol, Manel

doi:10.1007/s00384-004-0736-8

Cited by 84 publications

(59 citation statements)

References 17 publications

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

“…Seven RCTs15 19, 22 23, 25, 26, 27 and one cohort study28, involving 2429 patients, examined rates of SSI in patients who received a preoperative oral combination of an oral aminoglycoside (kanamycin or neomycin) and metronidazole, along with i.v. antibiotic prophylaxis and MBP, in comparison with patients given only i.v.…”

Section: Resultsmentioning

confidence: 99%

“…Two RCTs23 27, with 779 patients, examined rates of postoperative ileus in patients given preoperative oral antibiotic prophylaxis, in combination with i.v. antibiotic prophylaxis and MBP, and in those given only intravenous antibiotic prophylaxis with MBP.…”

Section: Resultsmentioning

confidence: 99%

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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

2018

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BackgroundSurgical‐site infection (SSI) is a potentially serious complication following colorectal surgery. The present systematic review and meta‐analysis aimed to investigate the effect of preoperative oral antibiotics and mechanical bowel preparation (MBP) on SSI rates.MethodsA systematic review of PubMed, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials was performed using appropriate keywords. Included were RCTs and observational studies reporting rates of SSI following elective colorectal surgery, in patients given preoperative oral antibiotic prophylaxis, in combination with intravenous (i.v.) antibiotic prophylaxis and MBP, compared with patients given only i.v. antibiotic prophylaxis with MBP. A meta‐analysis was undertaken.ResultsTwenty‐two studies (57 207 patients) were included, of which 14 were RCTs and eight observational studies. Preoperative oral antibiotics, in combination with i.v. antibiotics and MBP, were associated with significantly lower rates of SSI than combined i.v. antibiotics and MBP in RCTs (odds ratio (OR) 0·45, 95 per cent c.i. 0·34 to 0·59; P < 0·001) and cohort studies (OR 0·47, 0·44 to 0·50; P < 0·001). There was a similarly significant effect on SSI with use of a combination of preoperative oral aminoglycoside and erythromycin (OR 0·40, 0·25 to 0·64; P < 0·001), or preoperative oral aminoglycoside and metronidazole (OR 0·51, 0·39 to 0·68; P < 0·001). Preoperative oral antibiotics were significantly associated with reduced postoperative rates of anastomotic leak, ileus, reoperation, readmission and mortality in the cohort studies.ConclusionOral antibiotic prophylaxis, in combination with MBP and i.v. antibiotics, is superior to MBP and i.v. antibiotic prophylaxis alone in reducing SSI in elective colorectal surgery.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

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

2018

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Randomized, Multicenter Trial of Antibiotic Prophylaxis in Elective Colorectal Surgery

Fujita¹

2007

Arch Surg

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Hypothesis: Use of prophylactic antibiotics in elective colorectal surgery is essential. Although singledose prophylactic antibiotics are recommended, the efficacy of single-dose cephalosporin without metronidazole and oral antibiotics is not fully proven. We conducted a multicenter, randomized trial of a single dose vs 3 doses of the second-generation cephalosporin cefmetazole. Design: A prospective, randomized, multicenter trial in patients undergoing elective colorectal surgery. Setting: Seven major hospitals in Japan that offer cancer treatment.

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Association of Mechanical Bowel Preparation and Oral Antibiotics Before Elective Colorectal Surgery With Surgical Site Infection

et al. 2018

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Key Points Question Which approach is best to reduce surgical site infections and anastomotic leak in colorectal surgery: mechanical bowel preparation with oral antibiotics, oral antibiotics only, mechanical bowel preparation only, or no preparation? Findings Among 38 randomized clinical trials (8458 patients) in this network meta-analysis, mechanical bowel preparation with oral antibiotics was associated with the lowest rate of surgical site infections, reducing both incisional and organ/space infections. There was no significant difference in anastomotic leak rate between the 4 approaches. Meaning Mechanical bowel preparation with oral antibiotics is the best approach to reduce surgical site infections in patients undergoing colorectal surgery.

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

Cited by 84 publications

References 17 publications

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

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

Randomized, Multicenter Trial of Antibiotic Prophylaxis in Elective Colorectal Surgery

Association of Mechanical Bowel Preparation and Oral Antibiotics Before Elective Colorectal Surgery With Surgical Site Infection

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