[Antibiotic prophylaxis in colorectal surgery].
In elective colorectal surgery, the benefit of preoperative antibiotic prophylaxis is well established, with a reduction in wound infection rate to less than 10%. The antimicrobial agent used has to be active against aerobic and anaerobic pathogens such as Escheria coli and Bacteriodes fragilis. The efficacy of three schemes of administration: oral and/or parenteral prophylaxis associated with a mechanical preparation, has been demonstrated. Oral antibiotic administration is current practice in USA; the most widely used oral regimen is the combination of erythromycin and neomycin given the day before surgery. Parenteral prophylaxis with a cephalosporin active against Bacteriodes fragilis such as cefoxitin and cefotetan, is preferred in Europe. The issue of whether a systemic prophylaxis should be added to the oral regimen or not has not yet been resolved. However it seems that the association should be proposed in various situations: patients with a high risk factors score (rectal resection and operations lasting more than three hours), patients with incomplete mechanical preparation, delay of the onset of surgery after the last oral dose.
Dellamonica
P
P
Unité des Maladies Infectieuses et Tropicales, Hôpital de l'Archet, Nice.
Bernard
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E
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003106:Colon / Q000601:surgery*; D004359:Drug Therapy, Combination / Q000008:administration & dosage / Q000627:therapeutic use; D017558:Elective Surgical Procedures; D005060:Europe; D006801:Humans; D011292:Premedication; D011300:Preoperative Care; D012007:Rectum / Q000601:surgery*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014481:United States
D000900:Anti-Bacterial Agents
Antibioprophylaxie en chirurgie colorectale.