Cefoxitin versus Erythromycin, Neomycin, and Cefazolin in Colorectal Operations

Abstract

Perioperative parenteral cefoxitin was compared with oral erythromycin, neomycin and parenteral cefazolin in a prospective, double-blind, randomized evaluation of 119 patients undergoing colorectal operations. Patients receiving cefoxitin had a higher wound infection rate than patients receiving erythromycin-neomycin-cefazolin (12.5% v 3.2%, respectively, p = .06). A direct correlation existed between the duration of the operation and the infection rate. Cefoxitin prophylaxis was as effective as erythromycin-neomycin-cefazolin in patients undergoing surgical procedures of 4 hours or less (infection rates of 4.8% and 4.0%, respectively). However, for surgical procedures lasting more than 4 hours, 5 of 14 patients (37.5%) receiving cefoxitin developed a wound infection v 0 of 13 patients receiving erythromycin-neomycin-cefazolin (p less than .05). It is speculative as to whether frequent two-gram doses of cefoxitin given during the operation would provide prophylaxis equivalent to erythromycin-neomycin-cefazolin.

Meta‐analysis of oral antibiotics, in combination with preoperative intravenous antibiotics and mechanical bowel preparation the day before surgery, compared with intravenous antibiotics and mechanical bowel preparation alone to reduce surgical‐site infections in elective colorectal surgery

“…A further three studies were excluded as they were duplicate publications using cohorts already included in the meta‐analysis11, 12, 13. The remaining 22 studies were included in the review, of which 14 were RCTs14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, and eight were observational cohorts2 4, 28, 29, 30, 31, 32, 33 ( Table 1; Table   S1, supporting information). These studies included a total of 57 207 patients.…”

“…S1 (supporting information). Of the included RCTs, five14 16, 18 20, 22 were double‐blinded, three15 17, 23 were single‐blinded, and the remainder were unblinded. Most of the included cohort studies were at low risk of bias.…”

“…In the 14 RCTs14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, involving 3014 patients, rates of SSI in patients given preoperative oral antibiotic prophylaxis, in combination with i.v. antibiotic prophylaxis and MBP, were compared with those in patients who received only i.v.…”

“…Seven RCTs14 16, 17, 18 20, 21 24, involving 1141 patients, examined rates of SSI in patients given a preoperative oral combination of an oral aminoglycoside (kanamycin or neomycin) and erythromycin, along with i.v. antibiotic prophylaxis and MBP, in comparison with patients who received only i.v.…”

“…A sensitivity analysis was undertaken, with only RCTs that employed double‐blinding used in the meta‐analysis14 16, 18 20, 22. There was minimal heterogeneity between studies ( I 2 = 0 per cent, P = 0·44), and therefore a fixed‐effect model was used.…”