[Effectiveness of antibiotic premedication in colonic surgery]

The value of preoperative bowel preparation with antibiotics in colon surgery was studied in a prospective randomized trial: 58 patients received only mechanical and dietary preparation and 50 patients were treated additionally with a combination of neomycin and bacitracin 4 days preoperatively. Bacteriologic studies of stools from the day before beginning of preparation and from the day before surgery which were done quantitatively per 1 gram stool revealed that the fecal flora of 90% of the patients with colonic disease is abnormal. After antibiotic treatment a significant reduction of Escherichia coli, Bacteroides, Bifidus, Clostridium, and Proteus was obtained in more than 70% of the patients. The effect on Klebsiella was poor. Candida were increased in 86% of the cases without resulting in a systemic candida infection. In the stool samples of 16 patients no bacteria were found after antibiotic treatment. If there was a high bacterial count in the preoperative stool infectious complications followed postoperatively. The rate of infectious complications was 28 (48.7%) in the control group and 7 (14%) in the antibiotic group. This significant lower rate of complications speaks in favor of preoperative bowel preparation with neomycin and bacitracin, especially in the absence of adverse side-effects.