Colectomy, mucosal proctectomy, and ileal pouch-anal anastomosis. A prospective trial of optimal antibiotic management.
The ideal prophylactic antibiotic regimen has not been established for patients undergoing colectomy, mucosal proctectomy, and endorectal ileoanal anastomosis, a prolonged operation frequently accompanied by abdominal and pelvic contamination and associated with an infection rate up to 20%. The aim of this study was to evaluate, in a prospective, randomized, double-blind fashion, the efficacy of a short perioperative course compared to an extended postoperative course of intravenous antibiotics (cefoxitin) in patients undergoing colectomy with ileoanal anastomosis. Forty patients with ulcerative colitis or familial polyposis coli received a mechanical and oral antibiotic bowel preparation and a standard three-dose perioperative course of intravenous cefoxitin. Patients then were randomized to receive intravenous cefoxitin, 1 g every 6 hours, or placebo for 5 days. No differences in overall postoperative morbidity were observed and neither group developed intra-abdominal, pelvic, or wound infections. It is concluded that a standard three-dose perioperative course of intravenous antibiotics provides adequate prophylaxis in the prevention of infectious complications in patients undergoing colectomy, mucosal proctectomy, and ileoanal anastomosis.
Becker
J M
JM
Department of Surgery, University of Utah School of Medicine, Salt Lake City.
Alexander
D P
DP
D011125:Adenomatous Polyposis Coli / Q000601:surgery; D000284:Administration, Oral; D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D002440:Cefoxitin / Q000008:administration & dosage / Q000627:therapeutic use; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000601:surgery; D004311:Double-Blind Method; D004359:Drug Therapy, Combination / Q000008:administration & dosage*; D004917:Erythromycin / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005736:Gardner Syndrome / Q000601:surgery; D006801:Humans; D007082:Ileum / Q000601:surgery*; D017053:Infection Control; D007262:Infusions, Intravenous; D008297:Male; D009355:Neomycin / Q000008:administration & dosage / Q000627:therapeutic use; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control; D011292:Premedication; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*
D004917:Erythromycin; D002440:Cefoxitin; D009355:Neomycin