title: Oral and Parenteral Versus Parenteral Antibiotic Prophylaxis in Elective Laparoscopic Colorectal Surgery (JMTO PREV 07-01): A Phase 3, Multicenter, Open-label, Randomized Trial.
abstract: OBJECTIVE
  To confirm the efficacy of oral and parenteral antibiotic prophylaxis (ABX) in the elective laparoscopic colorectal surgery.
  
  
  BACKGROUND
  There is no evidence for the establishment of an optimal ABX regimen for laparoscopic colorectal surgery, which has become an important choice for the colorectal cancer patients.
  
  
  METHODS
  The colorectal cancer patients scheduled to undergo laparoscopic surgery were eligible for this multicenter, open-label, randomized trial. They were randomized to receive either oral and parenteral prophylaxis (1 g cefmetazole before and every 3 h during the surgery plus 1 g oral kanamycin and 750 mg metronidazole twice on the day before the surgery; Oral-IV group) or parenteral prophylaxis alone (the same IV regimen; IV group). The primary endpoint was the incidence of surgical site infections (SSIs). Secondary endpoints were the incidence rates of Clostridium difficile colitis, other infections, and postoperative noninfectious complications, as well as the frequency of isolating specific organisms.
  
  
  RESULTS
  Between November 2007 and December 2012, 579 patients (289 in the Oral-IV group and 290 in IV group) were evaluated for this study. The incidence of SSIs was 7.26% (21/289) in the Oral-IV group and 12.8% (37/290) in the IV group with an odds ratio of 0.536 (95% CI, 0.305-0.940; P = 0.028). The 2 groups had similar incidence rates of C difficile colitis (1/289 vs 3/290), other infections (6/289 vs 5/290), and postoperative noninfectious complications (11/289 vs 12/290).
  
  
  CONCLUSIONS
  Our oral-parenteral ABX regimen significantly reduced the risk of SSIs following elective laparoscopic colorectal surgery.
authors.affiliation: *Department of Surgery, National Hospital Organization, Kyoto Medical Centre, Kyoto, Japan†Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan‡Department of Surgery, Faculty of Medicine, Saga University, Saga, Japan§Department of Surgery, Digestive Disease Centre, Kyoto Katsura Hospital, Kyoto, Japan¶Department of Surgery, Osaka Red Cross Hospital, Osaka, Japan||Department of Biostatistics and Epidemiology, Graduate school of Medicine, Yokohama City University, Yokohama, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Hata
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Suguru
authors.initials: S
authors.lastname: Hasegawa
authors.forename: Akinari
authors.initials: A
authors.lastname: Nomura
authors.forename: Koya
authors.initials: K
authors.lastname: Hida
authors.forename: Ryuta
authors.initials: R
authors.lastname: Nishitai
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamanokuchi
authors.forename: Takeharu
authors.initials: T
authors.lastname: Yamanaka
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Sakai
mesh_terms: D000368:Aged; D019072:Antibiotic Prophylaxis / Q000379:methods*; D015311:Cefmetazole / Q000008:administration & dosage*; D015179:Colorectal Neoplasms / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007612:Kanamycin / Q000008:administration & dosage*; D010535:Laparoscopy; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage*; D008875:Middle Aged; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D008795:Metronidazole; D015311:Cefmetazole; D007612:Kanamycin