Oral Neomycin Sulfate and Erythromycin Base Before Colon Surgery: A Comparison of Serum and Tissue Concentrations

Abstract

It is accepted that the use of oral neomycin sulfate and erythromycin base before colon surgery results in decreased numbers of intestinal bacteria. Intraluminal levels of these agents are reported to be very high, but systemic availability is still debated. The systemic levels were studied in 8 patients undergoing colon surgery. Each patient received neomycin sulfate and erythromycin base, 1 g each, 19, 18 and 9 hours preoperatively. Twelve samples from serum, one from wound muscle and one from the intestinal wall were obtained from each patient in the 26 hours after the initial dose. Considerable variation was observed among levels. The following means were calculated: peak serum levels were 3.4 and 0.59 micrograms/ml, muscle levels were 1.68 and 0.23 micrograms/g and intestinal wall levels were 6.4 and 12.9 micrograms/g for erythromycin and neomycin respectively. Observed times to peak levels were 19 and 12 hours after the initial dose for erythromycin and neomycin respectively. The detectable systemic concentrations that result when these agents are given orally for bowel preparation before colon surgery may contribute to the drugs' efficacy.

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

“…The combination of oral neomycin and erythromycin has been recommended for use as preoperative antibiotic prophylaxis for colorectal surgery in an advisory statement from the Medicare National Surgical Infection Prevention Project35. Outside North America, this figure is much lower.…”

“…There was no association between the combination of antibiotics and outcome, as long as an aminoglycoside was included. Aminoglycosides administered orally reach very low levels in the circulation35, and toxicity is vanishingly rare. It is suggested that future ERAS protocols should factor in a combination of MBP and short‐course oral antibiotic prophylaxis with an aminoglycoside and metronidazole, and i.v.…”

A Brief Course of Colon Preparation with Oral Antibiotics

“…2 Pharmacokinetic studies showed that kanamycin (or neomycin) was not absorbed and remained bacteriologically active within the lumen of the colon, while high intraluminal and serum levels of metronidazole (or erythromycin base) were found at the time of surgery (8 a.m.). 17 We evaluated a brief-course preoperative colon preparation with a 3-day postoperative prophylaxis of systemic antibiotics. The issue was whether or not the concominant administration of preoperative oral antibiotics with perioperative parenteral antibiotics was more effective in decreasing postoperative infection than a parenteral regimen alone.…”

Neomycin and bacitracin reduce the intestinal permeability in mice and increase the expression of some tight-junction proteins

“…Bacitracin has been used orally for the treatment of Clostridium difficile-associated diarrhoea and colitis (3,4). Oral neomycin is indicated for suppression of intestinal bacterial flora in patients undergoing colorectal surgery (5,6) and as a means of decreasing colonic bacteria and the production of ammonia in hepatic encephalopathy (7). Recently, it has been reported that the oral administration of neomycin plus bacitracin prevents diarrhoea induced by chemotherapy drugs used in the treatment of advanced colorectal cancer (8).…”