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Clin Colon Rectal Surg 2003; 16(2): 101-108
DOI: 10.1055/s-2003-40589
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

The Role of Perioperative Antibiotics in Colorectal Surgery

Terry C. Hicks1 , Michael J. Stamos2
  • 1Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana
  • 2University of California, Irvine Medical School, Division of Colon and Rectal Surgery, UC Irvine Medical Center, Orange, California
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Publication History

Publication Date:
18 July 2003 (online)

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ABSTRACT

After more than the 60 years since the first report of antibiotic use for prevention of infection following colorectal surgery, the knowledge base has increased dramatically. Despite this expansion of knowledge, the appropriate use of prophylactic antibiotics remains controversial. Options include intravenous antibiotics, oral antibiotics, or both. The available data support concomitant use of oral and intravenous antibiotics and, perhaps more importantly, appropriate timing of the intravenous antibiotics within 2 hours (or less) of surgery start time. In selecting an oral antibiotic regime, it is imperative that both aerobic and anaerobic activities are present in the antibiotics used (i.e., neomycin plus metronidazole or erythromycin base). If a parenteral antibiotic is used without a combination of an oral antimicrobial, it must adhere to the same broad-spectrum coverage of both aerobes and anaerobes. Oral agents should be administered in limited doses the day before the operation. Parenteral antibiotics must be administered in a timely fashion to ensure that adequate tissue levels are present at the time of the incision and be of adequate duration to produce adequate tissue levels during the expected duration of contamination

KEYWORDS

Oral antibiotics - parenteral antibiotics - bacteriology - bowel preparation

REFERENCES

  • 1 Gay Jr C F. Medicolegal issues. In: Hicks TC, Beck DE, Opelka FG, Timmcke AE, eds. Complications of Colorectal Surgery Baltimore: Williams & Wilkins 1996: 468-477
    Search in Google Scholar
  • 2 Beck D E, Fazio V W. Current pre-operative bowel cleansing methods: a survey of American Society of Colon and Rectal Surgeons Members.  Dis Colon Rectum . 1990;  33 12-15
    PubMedSearch in Google Scholar
  • 3 O'Grady N P, Alexander M, Dellinger E P. et al . Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention.  MMWR Recomm Rep . 2002;  51(RR-10) 1-29
    PubMedSearch in Google Scholar
  • 4 Tyson R B, Spaulding E H. Should antibiotics be used in large bowel preparation?.  Surg Gynecol Obstet . 1959;  108 63
    PubMedSearch in Google Scholar
  • 5 Beck D E. Mechanical bowel cleansing.  Perspect Colon Rectal Surg . 1994;  7 97-114
    PubMedSearch in Google Scholar
  • 6 Platell C, Hall J. What is the role of mechanical bowel preparation in patients undergoing colorectal surgery?.  Dis Colon Rectum . 1998;  41 875-883
    PubMedSearch in Google Scholar
  • 7 Katz J A, Orkin B A. Bowel preparation for elective colon and rectal surgery.  Clin Colon Rectal Surg . 2003;  16 119-130
    PubMedSearch in Google Scholar
  • 8 Riddell M I. A review of the literature on preoperative prophylaxis of the bowel with antibacterial agents.  Am J Med Sci . 1952;  223 301
    PubMedSearch in Google Scholar
  • 9 Garlock J H, Seley G P. The use of sulfanilamide in surgery of the colon and rectum; preliminary report.  Surgery . 1939;  5 787
    PubMedSearch in Google Scholar
  • 10 Nichols R L, Holmes J W. Antibiotics in Colon Surgery and Surgery of the Alimentary Tract, 4th ed. Philadelphia: W.B Sanders; 150-163
  • 11 Nichols R L, Condon R E. Preoperative preparation of the colon.  Surg Gynecol Obstet . 1971;  132 323-337
    PubMedSearch in Google Scholar
  • 12 Alexander J W, Stinett J C, Ogle C K. et al . A comparison of immunologic profiles and their influence on bacteremia in surgical patients with a high risk of infection.  Surgery . 1979;  86 94-104
    PubMedSearch in Google Scholar
  • 13 Meakins J L, Pietsch J B, Bubenick O. et al . Delayed hypersensitivity: indicator of acquired failure of host defenses in sepsis and trauma.  Ann Surg . 1977;  86 241-250
    PubMedSearch in Google Scholar
  • 14 Cruse P JE, Foord R. A five-year prospective study of 23,649 wounds.  Arch Surg . 1973;  107 206-210
    CrossrefPubMedSearch in Google Scholar
  • 15 Connolly W B, Hunt T K, Sonne M. et al . Influence of distant trauma on local wound infection.  Surg Gynecol Obstet . 1969;  128 713-718
    PubMedSearch in Google Scholar
  • 16 Torchia N G. Perioperative blood transfusions and albumin administration are independent risk factors for the development of postoperative infections after colorectal surgery.  Can J Surg . 2000;  43 212-216
    PubMedSearch in Google Scholar
  • 17 Kurz A. Perioperative normothermia to reduce the incidence of surgical wound infection and shorten hospitalization.  N Engl J Med . 1996;  334 1209-1215
    CrossrefPubMedSearch in Google Scholar
  • 18 Smith G. Primary postoperative wound infection due to Staphylococcus pyogenes Curr Probl Surg .  1979;  16 1
    PubMedSearch in Google Scholar
  • 19 Shimada K, Sutter V L, Finegold S N. Effect of bile and deoxycholate on gram-negative anaerobic activity.  Appl Microbiol . 1970;  20 737-741
    PubMedSearch in Google Scholar
  • 20 Lindsay J T, Smith J W, McClugage Jr G S. et al . Affects of commonly used bowel preparations on large bowel mucosal-associated and luminal micro flora.  Dis Colon Rectum . 1990;  3 554-560
    PubMedSearch in Google Scholar
  • 21 Smith M B, Goradia V K, Holmes J W. et al . Suppression of the human mucosal-related colonic flora with prophylactic parenteral and/or oral antibiotics.  World J Surg . 1990;  14 636-641
    CrossrefPubMedSearch in Google Scholar
  • 22 Poth E J. Intestinal antisepsis in surgery.  JAMA . 1953;  153 1516
    PubMedSearch in Google Scholar
  • 23 Cohn Jr I. Antibiotics in colon surgery.  Gastroenterology . 1958;  35 583
    PubMedSearch in Google Scholar
  • 24 Nichols R L, Smith J W, Garcia R Y, Waterman R S, Holmes J. Current practices of preoperative bowel preparation among North American colorectal surgeons.  Clin Infect Dis . 1997;  24 609-619
    PubMedSearch in Google Scholar
  • 25 Cleary R K, Grossman R, Fernandez F B. et al . Metronidazole may inhibit intestinal colonization with Clostridium difficile Dis Colon Rectum .  1998;  41 464-467
    PubMedSearch in Google Scholar
  • 26 Beck D E, Fazio V W. Current pre-operative bowel cleansing methods: a survey of American Society of Colon and Rectal Surgeons Members.  Dis Colon Rectum . 1990;  33 12-15
    PubMedSearch in Google Scholar
  • 27 Solla J A, Rothenberger D A. Preoperative bowel preparation: a survey of colon and rectal surgeons.  Dis Colon Rectum . 1990;  33 154-159
    PubMedSearch in Google Scholar
  • 28 Polk Jr C H, Lopez-Mayor J F. Postoperative wound infections. A prospective study of determinant factors and prevention.  Surgery . 1969;  66 97-103
    PubMedSearch in Google Scholar
  • 29 Baum M L, Anish D S, Chalmers T C. et al . A survey of clinical trials of antibiotic prophylaxis in colon surgery: evidence against further use of no-treatment controls.  N Engl J Med . 1981;  305 795-799
    PubMedSearch in Google Scholar
  • 30 Song F, Glenny A M. Antimicrobial prophylaxis in colorectal surgery: a systematic review of randomized controlled trials.  Br J Surg . 1998;  85 1232-1241
    CrossrefPubMedSearch in Google Scholar
  • 31 Evans C, Pollock A V. The reduction of surgical wound infection by prophylactic parenteral cephaloridine: a controlled clinical trial.  Br J Surg . 1973;  60 434-437
    PubMedSearch in Google Scholar
  • 32 Burton R C, Hughes E SR, Cuthbertson A M. Prophylactic use of gentamicin in colonic and rectal surgery.  Med J Aust . 1975;  2 597-599
    PubMedSearch in Google Scholar
  • 33 Brote I, Gillquist J, Hojer H. Prophylactic cephalothin in gastrointestinal surgery.  Acta Chir Scand . 1976;  142 238-245
    PubMedSearch in Google Scholar
  • 34 Kjellgren K, Sellstrom H. Effect of prophylactic systemic administration of cephalothin in colorectal surgery.  Acta Chir Scand . 1977;  143 473-477
    PubMedSearch in Google Scholar
  • 35 Eykyn S J, Jackson B T, Lockhart-Mummery H E. et al . Prophylactic perioperative intravenous metronidazole in elective colorectal surgery.  Lancet . 1979;  2 761-764
    PubMedSearch in Google Scholar
  • 36 Periti P, Mazzei T, Tonelli F. et al . Single dose cefotetan versus multiple dose cefoxitin antimicrobial prophylaxis in colorectal surgery.  Dis Colon Rectum . 1989;  32 121-127
    PubMedSearch in Google Scholar
  • 37 Skipper D, Karran S J. A randomized prospective study to compare cefotetan with cefuroxime plus metronidazole as prophylaxis in elective colorectal surgery.  J Hosp Infect . 1992;  21 72-77
    PubMedSearch in Google Scholar
  • 38 Hall C, Curran F, Burdon D W, Keighley M R. A randomized trial to compare amoxicillin/clavulanate with metronidazole plus gentamicin in prophylaxis in elective colorectal surgery.  J Antimicrob Chemother . 1989;  24 195-202
    PubMedSearch in Google Scholar
  • 39 Corman M, Robertson W, Lewis T. et al . A controlled clinical trial. Cefuroxime, metronidazole, and cefoxitin as prophylactic therapy for colorectal surgery.  Complic Surg . 1993;  12 37-40
    PubMedSearch in Google Scholar
  • 40 Silver A, Eichorn A, Kral J. et al . Timeliness and use of antibiotic prophylaxis in selected inpatient surgical procedures.  Am J Surg . 1996;  171 548-552
    CrossrefPubMedSearch in Google Scholar
  • 41 Coppa G F, Eng K, Gouge T H. et al . Parenteral and oral antibiotics in elective colon and rectal surgery. A prospective randomized trial.  Am J Surg . 1983;  145 62-65
    CrossrefPubMedSearch in Google Scholar
  • 42 Condon R E, Bartlett J G, Greenlee H. et al . Efficacy of oral and systemic antibiotic prophylaxis in colorectal operations.  Arch Surg . 1983;  118 496-502
    PubMedSearch in Google Scholar
  • 43 Schoetz Jr J D, Roberts P L, Murray J J. et al . Addition of parenteral cefoxitin to regimen of oral antibiotics for elective colorectal operations. A randomized prospective study.  Ann Surg . 1990;  212 209-212
    PubMedSearch in Google Scholar
  • 44 Stellato T A, Danzier L H, Gordon N. et al . Antibiotics in elective colon surgery. A randomized trial of oral, systemic, and oral/systemic antibiotics for prophylaxis.  Am Surg . 1990;  56 251-254
    PubMedSearch in Google Scholar
  • 45 Condon R E, Bartlett J G, Nichols R L. et al . Preoperative prophylactic cephalothin fails to control septic complications of colorectal operations: Results of controlled clinical trial-a Veterans Administration Cooperative Study.  Am J Surg . 1979;  137 68-74
    CrossrefPubMedSearch in Google Scholar
  • 46 Lewis R T. Oral versus systemic antibiotic prophylaxis in elective colon surgery: a randomized study and meta-analysis send a message from the 1990's.  Can J Surg . 2002;  45 173-180
    PubMedSearch in Google Scholar
  • 47 Kaiser A B, Herrington J L, Jacobs J K. et al . Cefoxitin versus erythromycin, neomycin and cefazolin in colorectal operations: importance of duration of the surgical procedure.  Ann Surg . 1983;  198 525-530
    PubMedSearch in Google Scholar
  • 48 Martin C, Portet C, Lambert D. et al . Pharmacokinetics and tissue penetration of single-dose cefotetan used for antimicrobial prophylaxis in patients undergoing colorectal surgery.  Antimicrob Agents Chemother . 1992;  36 1115-1118
    PubMedSearch in Google Scholar
  • 49 Dellinger E P, Gross P A, Barrett T L. et al . Quality standard for antimicrobial prophylaxis in surgical procedures. Infectious Diseases Society of America.  Clin Infect Dis . 1994;  18 422-427
    PubMedSearch in Google Scholar
  • 50 Page C P, Bohnen J M, Fletcher J R. et al . Antimicrobial prophylaxis for surgical wounds guideline for clinical care.  Arch Surg . 1993;  128 79-88
    PubMedSearch in Google Scholar
  • 51 Classen D C, Evans R S, Pestotink S L, Horn S D, Menolove R L, Burke J P. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection.  N Engl J Med . 1992;  326 281-286
    CrossrefPubMedSearch in Google Scholar
  • 52 Wong-Beringer A, Corelli R L, Schrock T R, Guglielmo B J. Influence of timing of antibiotic administration on tissue concentrations during surgery.  Am J Surg . 1995;  169 379-381
    CrossrefPubMedSearch in Google Scholar
  • 53 Esposito S. Is single-dose antibiotic prophylaxis sufficient for any surgical procedure?.  J Chemother . 1999;  11 556-564
    PubMedSearch in Google Scholar
  • 54 Alexander J W, Alexander N S. The influence of route of administration on wound fluid concentration of prophylactic antibiotics.  J Trauma . 1976;  16 488-495
    PubMedSearch in Google Scholar
  • 55 Nash A G, Hugh T B. Topical ampicillin and wound infections in colon surgery.  BMJ . 1967;  1 471-472
    PubMedSearch in Google Scholar
  • 56 Andersen B, Korner B, Ostergaard A H. Topical ampicillin against wound infection after colorectal surgery.  Ann Surg . 1972;  176 129-132
    PubMedSearch in Google Scholar
  • 57 Pollock A V, Froome K, Evans M. The bacteriology of primary wound sepsis in potentially contaminated abdominal operations: the effect of irrigation, povidone-iodine and cephaloridine on the sepsis rate assessed in a clinical trial.  Br J Surg . 1978;  65 76-80
    PubMedSearch in Google Scholar
  • 58 Mehigan D, Zuidema G D, Cameron J L. The world of systemic antibiotics in operations upon the colon.  Surg Gynecol Obstet . 1981;  153 573-576
    PubMedSearch in Google Scholar
  • 59 Juul P, Merrild U, Kronboes O. Topical ampicillin in addition to a systemic antibiotic prophylaxis in elective colorectal surgery: a prospective randomized study.  Dis Colon Rectum . 1985;  28 804-806
    PubMedSearch in Google Scholar
  • 60 Salvati E T, Rubin J, Eisenstat T E. et al . Value of subcutaneous and intraperitoneal antibiotics in reducing infection in clean contaminated operations of the colon.  Surg Gynecol Obstet . 1988;  167 315-318
    PubMedSearch in Google Scholar