A Single Dose Tinidazole and Doxycycline Prophylaxis in Elective Surgery of Colon and Rectum

Abstract

Antimicrobial prophylaxis with agents active against aerobic and anaerobic micro-organisms leads to a significant reduction of infectious complications following colorectal surgery. A single dose (1600 mg) of tinidazole (a nitroimidazole derivate) and doxycycline (400 mg) will provide serum and tissue values well above minimum inhibitory concentration (MIC) values for more than 24 hours. To reduce the unwanted side effects and cost of prolonged antimicrobial prophylaxis, a prospective controlled clinical multicenter study comparing the effect of a single dose before operation of tinidazole and doxycycline to five days of prophylaxis before operation in 234 patients undergoing elective colorectal surgery was undertaken. Six patients given a single dose of prophylaxis before operation (n = 118) developed infectious complication (5.1%). Prolongation of prophylaxis before operation for four days after operation (n = 116) did not lead to any further reduction of infectious complications. A single dose of tinidazole and doxycycline before operation is a simple and effective prophylaxis against infectious complications following elective colorectal surgery.

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on prevention of postoperative infection within an enhanced recovery pathway for elective colorectal surgery

“…In addition, given the emetogenicity of the standard Nichols-Condon prep (2 g of neomycin and 2 g of metronidazole PO twice), more modern, alternative antibiotic preps are sorely needed. Several interesting studies from Scandinavia used tinidazole, a better tolerated alternative to metronidazole, and doxycycline, to effect low SSI rates (Giercksky et al 1982 ; Ofstad et al 1980 ). Another interesting, yet unstudied, potential alternative OA bowel prep is rifaximin, a non-absorbable form of rifampin, which has proven efficacy in targeting both GI aerobes and anaerobes (Huang and DuPont 2005 ; Ojetti et al 2009 ).…”

Surgery and pre‐operative irradiation for locally advanced or recurrent rectal cancer in patients over 75 years of age

“…Antimicrobial prophylaxis consisted of one‐dose of doxycycline and metronidazole as reported previously [19]. Prophylaxis against thrombosis was enoxaparin 20–40 mg daily.…”

Clinical outcome in patients with complete pathologic response (pT0) to preoperative irradiation/chemo-irradiation operated for locally advanced or locally recurrent rectal cancer

“…The patients underwent surgery on a mean of 65 days after finishing radiotherapy. Antibiotic prophylaxis consisted of onedose of doxycycline and metronidazole as reported previously [9]. Prophylaxis against deep vein thrombosis was enoxaparin 20-40 mg daily.…”