Short-term systemic prophylaxis with cefoxitin and doxycycline in colorectal surgery. A prospective, randomized study

Area of Science:

• Surgical Infectious Diseases
• Pharmacology
• Colorectal Surgery

Background:

• Antibiotic prophylaxis is crucial in preventing surgical site infections (SSIs) following colorectal surgery.
• Choosing the optimal prophylactic agent balances efficacy, safety, and cost.
• Understanding the comparative effectiveness of commonly used agents like cefoxitin and doxycycline is essential.

Purpose of the Study:

• To compare the efficacy of cefoxitin and doxycycline as perioperative antibiotic prophylaxis in elective colorectal surgery.
• To assess the incidence of wound infections and intra-abdominal abscesses in patients receiving either cefoxitin or doxycycline.
• To evaluate the impact of antibiotic prophylaxis on infectious complications and potential ecological effects.

Main Methods:

• A comparative study involving 102 patients undergoing elective colorectal surgery.
• Patients received either cefoxitin (55 cases) or doxycycline (47 cases) for perioperative antibiotic prophylaxis.
• Postoperative outcomes, including wound infections and intra-abdominal abscesses, were monitored. Bacteriologic studies were performed.

Main Results:

• Wound infections occurred in 10 patients (cefoxitin group) and 4 patients (doxycycline group).
• Three intra-abdominal abscesses, all linked to anastomotic leakage, were observed (one cefoxitin, two doxycycline).
• No negative ecologic effects of prophylaxis were detected; short-term use effectively prevented serious infectious complications.

Conclusions:

• Both cefoxitin and doxycycline demonstrated efficacy in preventing serious infectious complications in colorectal surgery.
• The extended spectrum of cefoxitin offered no significant added benefit over doxycycline for prophylaxis in this setting.
• Patients with inflammatory bowel disease on salicylazosulfapyridine preoperatively face increased infection risk despite prophylaxis.