Antimicrobial prophylaxis in bowel surgery in The Netherlands

Area of Science:

• Infectious Diseases
• Surgical Oncology
• Pharmacology

Background:

• Antimicrobial prophylaxis is crucial for preventing surgical wound infections in bowel surgery.
• Antibiotic stewardship and formulary guidelines aim to optimize prophylaxis efficacy and safety.
• Variations in guidelines can impact clinical practice and patient outcomes.

Purpose of the Study:

• To analyze antimicrobial prophylaxis guidelines for bowel surgery across Dutch hospitals.
• To identify commonly recommended antibiotics and dosing strategies.
• To assess adherence to evidence-based recommendations for surgical prophylaxis.

Main Methods:

• A review of 33 antibiotic formularies from 89 Dutch hospitals was conducted.
• Guidelines for colorectal, biliary, and gastroduodenal surgery were examined.
• Recommended antimicrobial agents and dosing frequencies were documented.

Main Results:

• Amoxicillin/clavulanic acid and cephalosporins (first/second-generation) were frequently recommended.
• Metronidazole was often co-administered with cephalosporins.
• Third-generation cephalosporins and broad-spectrum penicillins were less commonly advised.
• A significant proportion of formularies (52-66%) suggested multiple-dose regimens.

Conclusions:

• Current Dutch hospital formularies generally recommend effective agents for bowel surgery prophylaxis.
• The frequent recommendation of multiple-dose regimens warrants further investigation regarding optimal dosing strategies.
• Guidelines should be continuously updated to reflect the latest evidence on antimicrobial prophylaxis.