Comparison between systemic and oral antimicrobial prophylaxis in colorectal surgery.
In a prospective randomised trial in which 93 patients undergoing elective colorectal operations were given a short prophylactic course of metronidazole and kanamycin orally or systemically, postoperative sepsis occurred in only 3 (6.5%) of those given antimicrobials systemically, compared with 17 (36%) of those given oral prophylaxis (P less than 0.01). 15 of the 17 infections in patients who received antimicrobials orally were due to kanamycin-resistant bacteria present in the colon at operation. Bacterial overgrowth of Staphylococcus aureus was recorded in 6 of the patients who received oral therapy. Antibiotic-associated pseudomembranous colitis occurred in 7 patients, 6 of whom had received prophylaxis orally. These results indicate that oral administration of prophylactic antimicrobials in colon surgery should be avoided because of the risks of bacterial resistance, superinfection, and antibiotic-associated pseudomembranous colitis. Systemic per-operative antimicrobial prophylaxis is safer and more effective.
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D002986:Clinical Trials as Topic; D003106:Colon / Q000382:microbiology; D003110:Colonic Neoplasms / Q000601:surgery*; D004341:Drug Evaluation; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D007273:Injections, Intramuscular; D007275:Injections, Intravenous; D007612:Kanamycin / Q000008:administration & dosage*; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage*; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D011897:Random Allocation; D012004:Rectal Neoplasms / Q000601:surgery*; D013530:Surgical Wound Infection / Q000517:prevention & control*
D008795:Metronidazole; D007612:Kanamycin