A prospective randomized study of prophylactic mannitol (10%)-neomycin-cefotaxime therapy in patients undergoing...

A prospective randomized trial was performed to assess the effectiveness of 10% mannitol, oral neomycin, and intravenous cefotaxime in preventing septic complications following elective colonic and rectal surgery in 99 patients. In each of the three regimens, 10% mannitol and oral neomycin were given preoperatively. In regimen 1 (34 patients) intravenous cefotaxime was given perioperatively. In regimen 2 (33 patients) cefotaxime was given perioperatively and for 24 hours postoperatively. Regimen 3 (32 patients) was the same as regimen 2 except that cefazolin sodium was substituted for cefotaxime. Septic complications developed in one patient each on regimens 1 and 3. There were no infections in the patients on regimen 2. This study demonstrates that bowel preparation with 10% mannitol and oral neomycin, coupled with a short perioperative course of cefotaxime or cefazolin sodium, is effective in controlling the septic complications of elective colorectal surgery, and the combinations are simple, safe, and cost effective.