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Single or multiple doses of metronidazole and ampicillin in elective colorectal surgery. A randomized trial
Abstract:
A randomized trial including 294 patients was performed to evaluate the prophylactic effect of single vs. multiple doses of antibiotics in elective colorectal surgery. All patients received 1.5 g metronidazole and 3.0 g ampicillin peroperatively and were randomized to: no further prophylactic antibiotic treatment, or ampicillin 1 g X 3 and metronidazole 0.5 g X 3 given intravenously during the second and third postoperative days. Deep wound infection was seen in 9/149 (6 percent) receiving a single dose and in 8/145 (6 percent) receiving multiple doses. No differences were found in the two groups between frequencies of anastomotic dehiscences, intra-abdominal abscesses, sepsis, and pulmonary infections. The two groups were similar according to distribution of sex, age, diagnosis, and type of surgery. A single peroperative dose of metronidazole and ampicillin is a simple and satisfactory antibiotic prophylaxis in elective colorectal surgery.
Insights
A single dose of antibiotics is as effective as multiple doses for preventing infections after colorectal surgery. This finding simplifies prophylactic antibiotic regimens for patients undergoing elective procedures.
Area of Science:
- Surgical Oncology
- Infectious Diseases
- Pharmacology
Background:
- Antibiotic prophylaxis is standard for preventing surgical site infections in colorectal surgery.
- Optimal dosing strategies for prophylactic antibiotics remain an area of investigation.
Purpose of the Study:
- To compare the efficacy of a single perioperative antibiotic dose versus multiple postoperative doses in elective colorectal surgery.
Main Methods:
- A randomized trial involving 294 patients undergoing elective colorectal surgery.
- Patients received a single perioperative dose of metronidazole and ampicillin.
- Randomization to either no further antibiotics or multiple postoperative doses of ampicillin and metronidazole.
Main Results:
- Deep wound infection rates were similar (6%) in both single-dose and multiple-dose groups.
- No significant differences were observed in anastomotic dehiscence, intra-abdominal abscesses, sepsis, or pulmonary infections between groups.
- Patient demographics and surgical characteristics were comparable between the treatment arms.
Conclusions:
- A single perioperative dose of metronidazole and ampicillin provides satisfactory antibiotic prophylaxis for elective colorectal surgery.
- Simplifying antibiotic regimens may improve patient compliance and reduce healthcare costs.