Single and multiple dose cotrimoxazole and metronidazole in colorectal surgery

Higgins, April; Lewis, A. A. M.; Noone, Paul; Hole, Margaret L.

doi:10.1002/bjs.1800670206

Cited by 66 publications

(15 citation statements)

References 9 publications

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“…Although the frequency of systemic infections follow ing elective colorectal surgery in this study was low (1.8%) local wound and intra-abdominal infection rates were unacceptable when compared to the results of other centres using single-dose prophylaxis [ 1,[6][7][8], In a recent multicentre Norwegian study (267 patients) the infection rate was a remarkable 3.1 % (intra-abdominal sepsis 0%) using single-dose tinidazole and cefuroxime [1]. Bowel preparation, operative procedures and definition of wound infections were similar to our study, the only obvious difference being the choice of antibiotics.…”

Section: Discussionmentioning

confidence: 71%

Single-Dose Antibiotic Prophylaxis in Elective Colorectal Surgery

et al. 1989

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In a randomized controlled trial single-dose peroperative intravenous mezlocillin, 5 g (group 1, n = 51), was compared with single-dose mezlocillin, 5 g, and metronidazole, 500 mg (group 2, n = 58), in 109 patients undergoing elective colorectal surgery. The two groups were similar in terms of age, sex, underlying pathology, obesity, prolonged operations, operative procedure and operator status. There was no significant difference in postoperative complications – five deaths 4.6% (three group 1), two septicaemias 2% (both group 2), five intra-abdominal abscesses 5% (three group 1) and 34 (31 %) wound infections. The incidence of wound infection was not related to the obesity of the patient, underlying pathology, duration of operation, operative procedure or operator status. Although mezlocillin was active against all anaerobes isolated during the study, analysis of the pattern of isolated organisms suggests that its spectrum of activity and its efficacy against aerobes is inadequate, rendering it inappropriate as a single-dose prophylactic agent in elective colorectal surgery even in combination with metronidazole.

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Section: Discussionmentioning

confidence: 71%

Single-Dose Antibiotic Prophylaxis in Elective Colorectal Surgery

et al. 1989

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“…The most common organisms isolated were coliforms (23), Bacterioides (20), Proteus (5), Pseudomonas (3) and Enterococcus (3). Staphylococcus aureus was the sole organism isolated in only three out of 12 cultures and only one of these three was coagulase positive.…”

Section: Details Ofthe Microbiological Isolatesmentioning

confidence: 99%

A randomized trial of one versus three doses of Augmentin as wound prophylaxis in at-risk abdominal surgery

Bates

Roberts

Smith

et al. 1992

Postgraduate Medical Journal

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Summary:In a randomized prospective trial of prophylactic antibiotics in at-risk abdominal surgery, one dose ofintravenous Augmentin (amoxycillin 250 mg and clavulanic acid 125 mg) on induction has been compared with three 8 hourly doses in 900 patients. Wound infection rates which included minor and delayed infections were very similar in those given one dose: 48/449 (10.7%) compared with those given three doses: 49/451 (10.9%) 95% confidence limits -4.25% + 3.9%.There were more septic and sepsis-related deaths in those patients given one dose (14 deaths) than in those given three doses (7 deaths) P > 0.1 95% CL -0.4% + 3.0%. However, there were more very elderly patients in the one dose group: 64% of the deaths were aged over 80 and all but one had an emergency operation. There was no difference in the other outcome measures studied which included non-fatal deep sepsis, length of postoperative hospital stay, duration of postoperative fever or the use of antibiotics for postoperative infection.One dose of a suitable intravenous antibiotic gives prophylaxis against wound infection in at-risk abdominal surgery which is at least as effective as multiple doses. However, there may be a risk of overwhelming systemic sepsis in very elderly patients having emergency surgery.

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“…The short-term peri-and postoperative parenteral ad ministration of antibiotics produces bacteriostatic or bac tericidal antibiotic concentrations in tissues such as the intestinal wall or peritoneum and should thereby prevent infection following contamination with intestinal organ isms [Bjerkeset and Digranes, 1980;Downing et al, 1977;Higgins et al, 1980], The idea that restriction of prophy laxis to a few hours or a few doses of antibiotic(s) would prevent the occurrence of resistance or changes in the intestinal flora has now been called into doubt [Ambrose et al, 1985],…”

Section: Choice Of Antibiotic Prophylaxismentioning

confidence: 99%