Hildebrandt J, Diettrich H
Zentralbl Chir. 1985;110(2-3):93-7.
A prospective clinical study was made to compare the effectiveness of a short-term oral antibiotic prophylaxis (neomycin) and a longacting oral-parenteral aerobically and anaerobically effective combination (neomycin, metronidazol, chloramphenicol) on the incidence of wound infections. All patients had orthograde lavage as a mechanical bowel preparation. Preoperative administration of the antibiotic combination before lavage could not reduce the relative aerobic bacterial count of the faeces. The incidence of wound infections was nearly identical with 4/89 in the neomycin group and 5/114 in the combination group. In the neomycin group there occurred 2/44 anastomotic dehiscences, but none in the combination group (0/65). Lethal complications were significantly higher in the neomycin group (7/89 to 2/114), whereas nonlethal complications were not significantly higher in the combination group. These data suggest that long-term, oral-parenteral prophylaxis with an antibiotic combination was not superior to a short-term, sole neomycin prophylaxis applied after orthograde lavage. Cleansing the bowel as completely as possible is a fundamental prerequisite for an effective antibiotic prophylaxis.
进行了一项前瞻性临床研究，以比较短期口服抗生素预防（新霉素）和长效口服 - 胃肠外有效联合用药（新霉素、甲硝唑、氯霉素）对伤口感染发生率的效果。所有患者均采用顺行灌洗作为机械性肠道准备。灌洗前给予抗生素联合用药并不能降低粪便中的需氧菌相对计数。伤口感染发生率在新霉素组为4/89，联合用药组为5/114，几乎相同。新霉素组发生2/44例吻合口裂开，而联合用药组未发生（0/65）。新霉素组的致命并发症显著更高（7/89比2/114），而联合用药组的非致命并发症没有显著更高。这些数据表明，抗生素联合进行长期口服 - 胃肠外预防并不优于顺行灌洗后应用的短期单一新霉素预防。尽可能彻底清洁肠道是有效抗生素预防的基本前提。
