Prophylaxis in bowel surgery.

The busy colon and rectal surgeon deals daily with a sea of bacteria. Using good surgical judgment as well as time-honored techniques and innovative equipment the postoperative results are generally good. The role that appropriately administered efficacious antibiotics play in this scenario should not be underestimated and can only be realized when historical controls are evaluated. The results of these studies of antibiotic bowel preparation suggest that many different approaches may be equally effective in reducing infection after elective colonic resection. Certain features, however, appear to be common to most of the studies. 1 Oral antibiotic regimens with both aerobic and anaerobic activity (e.g., neomycin/erythromycin base) were used. 2 The oral agents were given in limited doses the day before operation. 3 Addition of systemic antibiotic agents without broad-spectrum coverage to the oral regimen generally did not improve the results. 4 Use of broad-spectrum parenteral antibiotic agents alone was associated with a lower infection rate than the use of systemic agents having only limited coverage. 5 Addition of a broad-spectrum parenteral antibiotic to the oral antibiotics may further reduce the postoperative infection rate. 6 Parenteral or oral antibiotics should be administered only for short periods of time during the perioperative period. Since the general acceptance of the approach outlined above, infection rates have decreased and the number of clinical studies reported has drastically decreased. The authors do feel, however, that there is a need for further study to outline possible benefits of other appropriate regimens (34).