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Mechanical plus oral bowel preparation with paromomycin and metronidazole reduces infectious complications in

Matthias Mehdorn1, Christoph Lübbert2,3, Iris F Chaberny3,4

  • 1Department of Visceral, Transplant, Thoracic and Vascular Surgery, Leipzig University Hospital, Liebigstr. 20, D-04103, Leipzig, Germany.

International Journal of Colorectal Disease
|April 25, 2021
PubMed
Abstract

Insights

Preoperative oral antibiotics, paromomycin and metronidazole, significantly reduced infectious complications in elective colorectal surgery. This combination therapy also decreased superficial surgical site infections and showed a trend toward fewer abscesses and leaks.

Area of Science:

  • Surgical Oncology
  • Infectious Diseases
  • Pharmacology

Background:

  • Infectious complications occur in up to 30% of elective colorectal surgeries.
  • Preoperative bowel decontamination is explored to minimize these risks.
  • Oral antibiotic combinations are frequently studied, but paromomycin and metronidazole have not been evaluated.

Purpose of the Study:

  • To assess the efficacy of oral paromomycin and metronidazole in reducing postoperative infectious complications.
  • To compare infectious complication rates in patients undergoing elective colorectal surgery with and without this specific oral antibiotic regimen.

Main Methods:

  • Prospective single-center study with a matched-pair retrospective cohort design.
  • Evaluated postoperative infectious complications including superficial site infections, organ space abscesses, and anastomotic leakage.
  • Analyzed data from 92 matched patients (101 initially included).

Main Results:

  • Overall infectious complications were significantly reduced in the intervention group (15.2% vs 30.8%, p=0.018).
  • Superficial surgical site infections decreased significantly (8.7% vs 19.6%, p=0.041).
  • Trends showed decreased frequencies of intra-abdominal abscesses and anastomotic leakage; length of stay was almost significantly reduced (p=0.057).

Conclusions:

  • Oral paromomycin and metronidazole, combined with intravenous ertapenem, effectively reduce infectious complications in elective colorectal surgery.
  • This regimen is a promising strategy for improving surgical outcomes and patient recovery.
Keywords:
Antibiotic bowel preparationColorectal resectionsMechanic bowel preparationParomomycinSurgical site infections

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