Comparison Between Systemic and Oral Antimicrobial Prophylaxis in Colorectal Surgery

Keighley, M. R. B.; Arabi, Y.; Alexander-Williams, J; Youngs, Denise; Burdon, D. W.

doi:10.1016/s0140-6736(79)91373-4

Cited by 150 publications

(59 citation statements)

References 13 publications

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“…Since Bacteroides fragilis and other anaerobic bacteria are among the main pathogens encountered in infections after colorectal surgery, antibiotics with a spectrum of activity extended to these organisms are usually advocated (1). Antibiotic regimens which do not eliminate anaerobic fecal pathogens fail to control postoperative septic complications of colorectal operations (5, 13).Nitroimidazole derivatives such as metronidazole are commonly used in this situation (3,8,12,22 …”

mentioning

confidence: 99%

Pharmacokinetics and tissue penetration of a single dose of ornidazole (1,000 milligrams intravenously) for antibiotic prophylaxis in colorectal surgery

Martin

Bruguerolle

Mallet

et al. 1990

Antimicrob Agents Chemother

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Levels in serum and tissue penetration of ornidazole were studied after a single intravenous injection of 1,000 mg given to 14 patients for prophylaxis of surgical infection. They were scheduled for elective colorectal surgery. Adequate levels in blood (2MIC for 90% of Bacteroides fragilis strains tested) were found in all patients throughout the procedure and up to hour 24. Mean-maximal (15 min) and last-determined (24 h) ornidazole levels in serum were 24 5.2 and 6.3 1.4 mg/liter, respectively. 13-Phase elimination half-life was 14.1 + 2.7 h, and clearance and apparent volume of distribution were 47 + 12 ml/min and 0.9 + 0.13 liters/kg, respectively. In all patients, adequate levels in tissue were found in the abdominal wall and the epiploic fat at time of incision and in the colonic wall at time of anastomosis. At time of closure, all but one patient had adequate levels in tissue in the abdominal wall and the epiploic fat. No anaerobic nor aerobic infection occurred in the study patients.The benefit of short-term antimicrobial courses for prevention of postoperative infection has been demonstrated for selected surgical procedures, among them colorectal surgery (4,11,23). Antimicrobial agents for prophylaxis should be selected on the basis of their spectrum of activity against pathogens most likely to contaminate the surgical wound (11). Since Bacteroides fragilis and other anaerobic bacteria are among the main pathogens encountered in infections after colorectal surgery, antibiotics with a spectrum of activity extended to these organisms are usually advocated (1). Antibiotic regimens which do not eliminate anaerobic fecal pathogens fail to control postoperative septic complications of colorectal operations (5, 13).Nitroimidazole derivatives such as metronidazole are commonly used in this situation (3,8,12,22 MATERIALS AND METHODSThis study received the approval of the ethical committee of our institution, and all patients gave their informed consent. Fourteen patients were scheduled for elective rectal or colonic surgery. They were 10 men and 4 women with a mean age of 66 5 years and a mean weight of 67 + 8 kg. None had a history of allergic reaction to ornidazole. All patients had normal renal and hepatic function. They had a 2-day mechanical bowel preparation consisting of low-residue diet, purgation, and bowel washouts in the evening. Patients did not present any clinical or laboratory signs of infection and were not receiving any antibiotic therapy before surgery. Before induction of anesthesia, patients were given a single dose of 1,000 mg of ornidazole intravenously (i.v.) administered over 30 min via an arm catheter, at a constant flow rate with an automatic pump. Blood samples were collected from a central venous line (right internal jugular vein) before ornidazole injection and 15 min (maximum concentration), 45 min, and 1, 2, 3, 4, 5, 6, 8, 10, 12, 16, 20, and 24

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mentioning

confidence: 99%

Pharmacokinetics and tissue penetration of a single dose of ornidazole (1,000 milligrams intravenously) for antibiotic prophylaxis in colorectal surgery

Martin

Bruguerolle

Mallet

et al. 1990

Antimicrob Agents Chemother

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“…The most common pathogens are Escherichia coli and Bacteroides fragilis. When antibiotic prophylaxis is not employed, reported wound infection rates after colonic surgery vary from over 20% to 77% [4,10,33,[41][42][43][44][45], A positive effect can be obtained by orthograde rinsing [12], In the United States, the nonabsorbable enteral preparation of oral neomycin and an erythromycin base is the favorite means of antibi otic prophylaxis and has been shown to be one of the most effective or even the best antibiotic regimen in colorectal surgery compared to systemic administration [46][47][48][49][50][51][52], Other studies have shown higher infection rates with oral antibiotics [53][54][55], although the intraluminal concentra tions of organisms were significantly lower than those found in the parenteral group. This suggests that it is tis sue concentration rather than intracolonic concentration that is critical in preventing infection.…”

Section: Colon and Rectummentioning

confidence: 99%

Standards of Antibiotic Prophylaxis in Abdominal Surgery

A¹,

Büchler²

1996

Dig Surg

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The prophylactic use of antimicrobial agents is recommended for the prevention of numerous postoperative infections. Except for oral bowel preparations, antimicrobial prophylaxis should be limited to the operative period. Prolonged perioperative prophylaxis has not been shown to enhance effectiveness. The possibilities for toxicity, resistant superinfections and rising costs are discussed. This article provides an overview together with the standards of antimicrobial prophylaxis in abdominal surgery, principles of antibiotic administration and the choice of appropriate agents.

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“…Since Bacteroides fragilis and other anaerobic bacteria are among the main pathogens encountered in infections after colorectal surgery, antimicrobial agents with a spectrum of activity against these organisms are most often advocated (1). Nitroimidazole derivatives, such as metronidazole or ornidazole, are commonly used (1,4,7,10,11). During colorectal surgery, bacterial contamination occurs primarily in two sites: (i) soft tissues with the risk of abcess or cellulitis and (ii) the abdominal cavity with the risk of peritonitis or intraabdominal abscess.…”

mentioning

confidence: 99%

Pharmacokinetics and tissue penetration of a single 1,000-milligram, intravenous dose of metronidazole for antibiotic prophylaxis of colorectal surgery

Martin

Sastre

Mallet

et al. 1991

Antimicrob Agents Chemother

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The levels of metronidazole in serum and tissue penetration of metronidazole were studied after prophylactic administration in 11 patients undergoing elective colorectal surgery. A single dose of 1,000 mg given intravenously was administered before surgery. Adequate drug levels in serum (.MIC for 90% of strains tested [MIC90] for Bacteroides fragilis) were found in all patients throughout the procedure. Mean peak (15-min) and last-determined (24-h) metronidazole levels in serum were 28.8 ± 8 and 4.2 ± 1.7 mg/liter, respectively. The n-phase elimination half-life was 9.5 ± 2.3 h, and the clearance and apparent volume of distribution were 57 ± 13 ml/min and 0.7 ± 0.1 liter/kg, respectively. In the colonic wall at surgical anastomosis, tissue metronidazole levels .MIC90 for B. fragiis were found in 91% of patients. In the abdominal wall fat and epiploic fat, tissue metronidazole levels .MIC90 for B. fragilis were found in 40 to 60% of patients at surgical incision and closure. No anaerobic infection occurred during the study.

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Comparison Between Systemic and Oral Antimicrobial Prophylaxis in Colorectal Surgery

Cited by 150 publications

References 13 publications

Pharmacokinetics and tissue penetration of a single dose of ornidazole (1,000 milligrams intravenously) for antibiotic prophylaxis in colorectal surgery

Pharmacokinetics and tissue penetration of a single dose of ornidazole (1,000 milligrams intravenously) for antibiotic prophylaxis in colorectal surgery

Standards of Antibiotic Prophylaxis in Abdominal Surgery

Pharmacokinetics and tissue penetration of a single 1,000-milligram, intravenous dose of metronidazole for antibiotic prophylaxis of colorectal surgery

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