title: Orally Administered Trimethoprim-Sulfamethoxazole and Metronidazole as Infection Prophylaxis in Elective Colorectal Surgery.
abstract: BACKGROUND
  This randomized clinical trial evaluated orally administered trimethoprim-sulfamethoxazole and metronidazole (TSM) in elective colorectal surgery as prophylactic for post-operative surgical site infections (SSI).
  
  
  METHODS
  Patients undergoing elective colorectal resection were evaluated for inclusion. Randomized subjects received either orally administered TSM or intravenously administered cefuroxime and metronidazole (control group, CXM). The primary endpoint was the rate of SSI.
  
  
  RESULTS
  A total of 1073 subjects were randomized to either control (540) or TSM (533). 486 patients in the TSM group and 499 in the control group were followed-up with after 4 weeks. Thirty-seven (3.8%) patients were afflicted by SSI at discharge from hospital and 69 (7.0%) at follow-up four weeks after surgery. After four weeks, the rate of incisional SSI was 7.0% in the TSM group and 3.6% in the control group (p=0.022). For organ/space SSI and the other complications monitored in the study, no differences were observed between the groups.
  
  
  CONCLUSIONS
  Orally administered TSM as prophylaxis before elective colorectal surgery results in a low rate of organ/space SSI but an increased rate of incisional SSI compared with intravenously administered cefuroxime and metronidazole. Thus, when considering orally administered TSM, because of environmental concerns or for economic reasons, the slightly increased infection rate has to be kept in mind.
authors.affiliation: 1 Department of Surgery, Kalmar Hospital , Kalmar, Sweden .|2 Department of Surgery, Halland Hospital , Halmstad, Sweden .
authors.forename: Claes
authors.initials: C
authors.lastname: Hjalmarsson
authors.affiliation: 2 Department of Surgery, Halland Hospital , Halmstad, Sweden .
authors.forename: Jonas
authors.initials: J
authors.lastname: Karlberg
authors.affiliation: 2 Department of Surgery, Halland Hospital , Halmstad, Sweden .
authors.forename: Pelle
authors.initials: P
authors.lastname: Törnqvist
authors.affiliation: 3 Linköping University , Norrköping, Sweden .
authors.forename: Gunnar
authors.initials: G
authors.lastname: Arbman
authors.affiliation: 4 Department of Surgery, Skaraborg Hospital , Sweden .
authors.forename: Björn
authors.initials: B
authors.lastname: Frisk
authors.affiliation: 4 Department of Surgery, Skaraborg Hospital , Sweden .
authors.forename: Marina
authors.initials: M
authors.lastname: Modin
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000293:Adolescent; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods; D002444:Cefuroxime / Q000008:administration & dosage; D003107:Colorectal Surgery / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage*; D008875:Middle Aged; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control*; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage*
chemical_list: D000890:Anti-Infective Agents; D008795:Metronidazole; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D002444:Cefuroxime