Oral Antibiotics Without Mechanical Bowel Prep Reduce Infections After Colon Surgery

By Reuters Staff

May 13, 2020

NEW YORK (Reuters Health) - Oral antibiotics given the day before colon surgery can help prevent surgical-site infections without mechanical bowel preparation, according to a new randomized controlled trial.

"In patients scheduled to undergo elective colon resection, preoperative oral antibiotics should be used to reduce the incidence of surgical-site infections," Dr. Eloy Espin Basany of the Hospital Valle de Hebron at the Universitat Autonoma de Barcelona, in Spain, and colleagues conclude in The Lancet Gastroenterology and Hepatology.

Mechanical bowel preparation and oral non-absorbable antibiotics have been used as prophylaxis for surgical-site infections after colorectal surgery for decades, but there remains no consensus about whether the approach is beneficial, Dr. Basany and his colleagues note.

"To date, no large, multicentre, randomised controlled trial has been done to assess the effectiveness of oral antibiotics alone versus no treatment before colon surgery," they add.

The current study included five large hospitals in Spain, with 47 colorectal surgeons participating. Patients with neoplasia or diverticulitis requiring partial colon resection or total colectomy were randomized to receive two doses of ciprofloxacin 750 mg and three doses of metronidazole 250 mg during the 24 hours before surgery, or no oral antibiotics the day before surgery. All patients also received intravenous cefuroxime 1.5 g and metronidazole 1 g at anesthesia induction. Mechanical bowel preparation was not performed in either group

Thirty (11%) of the 269 patients in the control group developed surgical-site infections, versus 13 (5%) of the 267 who received antibiotics (P=0.013). The odds ratio of surgical site infection with antibiotics was 0.41 (P=0.008).

Twenty-eight percent of the control group patients had any complications, including surgical-site infections, versus 19% of the experimental group (P=0.017), with no difference in severity.

"Together with previous evidence, our study suggests that surgeons should implement oral antibiotics when preparing patients for elective colon surgery," the authors write. "Further research should focus on a better understanding of microbiome dynamics and how they are used to determine the relative risk of surgical-site infections in each patient, and also the effect of mechanical bowel preparation or no mechanical bowel preparation in patients with oral antibiotics, which is the basis of our next study."

SOURCE: https://bit.ly/2SOetRP Lancet Gastroenterology and Hepatology, online April 20, 2020.