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Elective colon surgery: clindamycin versus metronidazole prophylaxis.
Canadian Journal of Surgery. Journal Canadien De Chirurgie
|November 1, 1982
Summary
Clindamycin-neomycin prophylaxis was compared to metronidazole-neomycin for colon surgery. No wound infections occurred in patients receiving clindamycin, suggesting its potential to prevent surgical site infections.
Area of Science:
- Surgical Oncology
- Infectious Diseases
- Pharmacology
Background:
- Colorectal surgery carries a risk of surgical site infections (SSIs).
- Antibiotic prophylaxis is crucial for preventing SSIs in patients undergoing colon surgery.
- Metronidazole-neomycin is a common prophylactic regimen, but concerns exist regarding potential side effects and efficacy.
Purpose of the Study:
- To compare the efficacy of orally administered clindamycin-neomycin versus metronidazole-neomycin as prophylactic antibiotics in patients undergoing colon surgery.
- To evaluate the incidence of wound infections in both treatment groups.
- To assess colon tissue and serum levels of clindamycin.
Main Methods:
- A comparative study involving patients scheduled for colon surgery.
- Patients were randomized to receive either oral clindamycin-neomycin or oral metronidazole-neomycin.
- Wound infection rates were monitored post-operatively.
- Colonic content and mucosal tissue levels of clindamycin were measured.
Main Results:
- None of the 38 patients receiving clindamycin-neomycin developed wound infections.
- Three of the 43 patients receiving metronidazole-neomycin experienced wound infections.
- Clindamycin achieved significantly higher concentrations in colon contents and mucosa (8-10 times serum levels) compared to serum levels.
Conclusions:
- Orally administered clindamycin-neomycin demonstrated superior efficacy in preventing wound infections compared to metronidazole-neomycin in colon surgery patients.
- Clindamycin's high tissue penetration may contribute to its effectiveness.
- Clindamycin-neomycin represents a promising prophylactic option, potentially mitigating staphylococcal infections and preventing anastomotic site infections.