title: Suppression of the human mucosal-related colonic microflora with prophylactic parenteral and/or oral antibiotics.
abstract: The purpose of this investigation was to assess the effects of preoperative administration of parenteral antibiotics with or without concomitant preoperative administration of oral antibiotics on the colonic mucosal-related microflora. Thirty-one patients were studied in a prospective fashion. Group A patients (n = 8) had colonoscopic mucosal biopsies performed after mechanical bowel preparation. Group B patients (n = 5) received neomycin and erythromycin (NE), 1 g each following mechanical bowel preparation, at 1, 2, and 11 p.m. the evening prior to either elective colon resection (n = 2) or prior to colonoscopic biopsy (n = 3). Emergent trauma patients who had left colon or sigmoid perforations due to gunshot wounds requiring segmental resection comprised group C (n = 7). These patients received cefoxitin or cefotetan 2 g intravenously preoperatively. Individuals in group D (n = 11) all had elective left hemicolectomies or sigmoid resections due to nonobstructing malignancies. These patients underwent the same regimen as group B patients in addition to receiving intravenous cefoxitin perioperatively. Quantitative and qualitative bacterial cultures as well as scanning electron microscopy (SEM) were used to study the mucosa-associated flora. Tissue for culture and SEM were obtained from the pathologic specimen immediately after removal. The interval between the dosage of parenteral antibiotics to tissue removal was 3 hours in both groups. Anaerobic and aerobic counts were suppressed the greatest in patients receiving both oral and parenteral antibiotics (p = 0.0001). Mean anaerobic counts decreased from 3.4 X 10(7) in group A to 1.8 X 10(2) (mean cfu/g) in group D patients. Mean aerobic counts in group A decreased from 3.7 X 10(6) to 64 (mean cfu/g) in group D.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana 70112.
authors.forename: M B
authors.initials: MB
authors.lastname: Smith
authors.forename: V K
authors.initials: VK
authors.lastname: Goradia
authors.forename: J W
authors.initials: JW
authors.lastname: Holmes
authors.forename: S G
authors.initials: SG
authors.lastname: McCluggage
authors.forename: J W
authors.initials: JW
authors.lastname: Smith
authors.forename: R L
authors.initials: RL
authors.lastname: Nichols
mesh_terms: D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D003106:Colon / Q000187:drug effects / Q000382:microbiology*; D004733:Enema; D006801:Humans; D007262:Infusions, Intravenous; D007413:Intestinal Mucosa / Q000187:drug effects / Q000382:microbiology*; D008855:Microscopy, Electron, Scanning
chemical_list: D000900:Anti-Bacterial Agents