title: The use and abuse of antibiotics in elective colorectal surgery: the saga continues....
abstract: BACKGROUND
  The role of antibiotic prophylaxis in preventing post-operative complications in patients undergoing elective colorectal surgery is well established. Despite evidence that a single-dose prophylaxis is sufficient, the duration of antibiotic use in clinical practice is highly variable and surveys have identified persistent patterns of antibiotic abuse in elective colorectal surgery.
  
  
  METHODS
  We conducted a retrospective review of all patients who underwent elective colorectal surgery between 1998 and 2002 at the American University of Beirut Medical Center. A survey among general surgeons in Lebanon was also performed to investigate the pattern of antibiotic prophylaxis used in such cases. The MEDLINE database (1966-2004) was searched for English-language articles and abstracts on antimicrobial use in elective colorectal surgery. Papers cited in relevant primary articles were also reviewed. Data were extracted and reviewed by all authors.
  
  
  RESULTS
  Two hundred and eleven matching patient-records were identified. A triple regimen including metronidazole, ampicillin and an aminoglycoside was the most commonly used preoperative prophylactic method. Patients received post-operative antibiotics for a mean of 6.66+/-2.62 days. The mean duration of post-operative antibiotic prophylaxis used by the interviewed surgeons was 4.31+/-1.08 days.
  
  
  CONCLUSIONS
  Our study confirms that even when strong evidence exists, surgeons fail to adhere to antibiotic prophylaxis guidelines. This pattern is not unique to Lebanon but is shared to a large extent by surgeons around the world. Adherence to published guidelines and improved education of surgeons are essential to the delivery of cost-effective medical practice.
authors.affiliation: Department of Internal Medicine, American University of Beirut Medical Center, Lebanon.
authors.forename: Elie
authors.initials: E
authors.lastname: Aoun
authors.forename: Sandra
authors.initials: S
authors.lastname: El Hachem
authors.forename: Heitham
authors.initials: H
authors.lastname: Abdul-Baki
authors.forename: Bassem
authors.initials: B
authors.lastname: Ayyach
authors.forename: Mohamad
authors.initials: M
authors.lastname: Khalifeh
authors.forename: Hani
authors.initials: H
authors.lastname: Chaar
authors.forename: Zeina A
authors.initials: ZA
authors.lastname: Kanafani
authors.forename: Souha S
authors.initials: SS
authors.lastname: Kanj
authors.forename: Ala I
authors.initials: AI
authors.lastname: Sharara