title: Failure of single-dose metronidazole prophylaxis in colorectal surgery. No benefit from high dosage or combination with nalidixic acid.
abstract: In an open prospective study of postoperative infectious complications, patients undergoing elective colorectal surgery were randomly allocated to one of three groups receiving parenteral single-dose antimicrobial prophylaxis (1 g or 3 g metronidazole or 1 g metronidazole + 3 g nalidixic acid). Because of an unacceptably high rate of surgical infection in all three groups (36%, 29% and 39%, p greater than 0.1) among the first 103 evaluable patients, the study was discontinued. Nalidixic acid--though effective in in vitro tests of bacterial susceptibility--thus was found to be of little or no value as prophylaxis against Gram-negative infection. As the observed infection rate when metronidazole was given at the start of operation was seven-fold that previously found in the same department when 1 g metronidazole was administered 3-4 hours preoperatively (28/103 vs. 2/50, p less than 0.01), the timing of metronidazole prophylaxis was assumed to be potentially important for its ability to protect also against aerobic postoperative infection.
authors.affiliation: Department of Surgery, University Hospital, Umeå, Sweden.
authors.forename: P A
authors.initials: PA
authors.lastname: Kling
authors.forename: L G
authors.initials: LG
authors.lastname: Burman
mesh_terms: D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000517:prevention & control*; D002986:Clinical Trials as Topic; D003106:Colon / Q000601:surgery*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage*; D008875:Middle Aged; D009268:Nalidixic Acid / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D011897:Random Allocation; D012007:Rectum / Q000601:surgery*; D013530:Surgical Wound Infection / Q000517:prevention & control
chemical_list: D008795:Metronidazole; D009268:Nalidixic Acid