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- Title
Antimicrobial prophylaxis in colorectal surgery: a systematic review of randomized controlled trials.
- Authors
Song, F.; Glenny, A.-M.
- Abstract
Background A systematic review was carried out to assess the relative efficacy of antimicrobial prophylaxis for the prevention of postoperative wound infection in patients undergoing colorectal surgery. Methods MEDLINE, EMBASE, the Cochrane Trials Register and the references cited in retrieved studies were searched to identify relevant trials published between 1984 and 1995. Results Some 147 relevant trials were identified. The quality of trials has improved over the past 12 years. The results confirm that the use of antimicrobial prophylaxis is effective for the prevention of surgical wound infection after colorectal surgery. There was no significant difference in the rate of surgical wound infections between many different regimens. However, certain regimens appear to be inadequate (e.g. metronidazole alone, doxycycline alone, piperacillin alone, oral neomycin plus erythromycin on the day before operation). A single dose administered immediately before the operation (or short-term use) is as effective as long-term postoperative antimicrobial prophylaxis (odds ratio 1·17 (95 per cent confidence interval (c.i.) 0·90–1·53)). There is no convincing evidence to suggest that the new-generation cephalosporins are more effective than first-generation cephalosporins (odds ratio 1·07 (95 per cent c.i. 0·54–2·12)). Conclusion Antibiotics selected for prophylaxis in colorectal surgery should be active against both aerobic and anaerobic bacteria. Administration should be timed to make sure that the tissue concentration of antibiotics around the wound area is sufficiently high when bacterial contamination occurs. Guidelines should be developed locally in order to achieve a more cost-effective use of antimicrobial prophylaxis in colorectal surgery.
- Subjects
ANTI-infective agents; COLON surgery
- Publication
British Journal of Surgery, 1998, Vol 85, Issue 9, p1232
- ISSN
0007-1323
- Publication type
Article
- DOI
10.1046/j.1365-2168.1998.00883.x