Systemic prophylaxis with doxycycline in surgery of the colon and rectum

A prospective randomized double-blind study on the effects of doxycycline as prophylactic antibiotic in elective colonic surgery is presented. 82 patients were evaluated. 39 were treated and 43 were controls. Mechanical cleansing of the bowel and a low residue diet for two days was routine. 200 mg doxycycline or placebo (2 capsules) were given orally 4-6 hours preoperatively and 100 mg (1 capsule) for 5 postoperative days. A significantly lower incidence of wound sepsis, intraabdominal complications and septicemia was registered in the doxycycline compared to the control group, 12.8 and 44.2 per cent respectively. After proctectomies, infections in the perineal field occurred in 3/9 and 5/10 cases in respective groups. In the doxycycline group, however, they were the only complication, whereas among the controls they were generally combined with infections in the abdominal field, 4/5. Peroperative contamination seemed to carry easier consequences in the doxycycline group. The results are discussed further. Doxycycline appears to be an excellent antibiotic for peroperative and short postoperative prophylactic use in potentially contaminated abdominal operations, not only because of its observed effects, but also when its negligible tendency to cause adverse reactions is taken into consideration. Bacterial cultures, concentrations of doxycycline in serum and tissues and their relation to infections will be accounted for and discussed in a separate paper.