Antibiotics covering aerobic and aerobic bacteria should be delivered orally and intravenously prior to colorectal surgery.  Antibiotics delivered within this framework will reduce the risk of postoperative SWI by at least 75%.  Further research is required to establish the optimal timing and duration of dosing, and frequency of longer-term adverse effects such as Clostridium difficile pseudomembranous colitis.
Prophylactic use of cefotaxime in colonic and rectal surgery.
Two hundred and seventeen patients, undergoing abdominal colonic and rectal surgery, received after randomization, the following regimen: group A (74 patients): cefotaxime 1 g intravenous at the induction of anaesthesia, the beginning of the resection, 4 and 8 h later; group B (72 patients): cefotaxime in the same regimen associated with ornidazole or metronidazole 0.5 g intravenous at the induction of anaesthesia and 0.5 g intravenous with the last injection of cefotaxime; group C (71 patients):cefotaxime following the same regimen as groups A and B and metronidazole orally 0.5 tds 3 days before surgery. All wounds were assessed daily, until discharge from hospital. Severe sepsis included: septicaemia, peritonitis, intra-abdominal abscess and extra-abdominal infections with death. Non-severe sepsis included all others. All the patients having a history of allergy to beta-lactam antibiotics and those with pre-operative infection were excluded. Mean age of the population was: 64.5 years. Seventy-seven patients had rectal cancer and 82 patients cancer of the colon; Twenty-five patients had inflammatory bowel disease, and in 33 others disease such as polyposis was present. Risk factors of post-operative infection were present in 115 cases (A, 36 patients; B, 37 patients; C, 42 patients). All three groups were very well matched for age, sex, type of intervention and diagnosis. Non-infectious complications appeared in 56 patients. Sepsis developed in 76 patients (A, 27 patients; B, 27 patients; C, 22 patients, no significant difference). Severe sepsis occurred in 14 patients (A, 6 patients; B, 4 patients; C, 4 patients, no significant difference) and in 62 patients non severe sepsis (A, 21 patients; B, 23 patients; C, 18 patients, no significant difference). Post-operative peritonitis was not seen. This study suggests that cefotaxime alone 4 g peri-operatively is useful in prophylaxis during rectal and colonic surgery.(ABSTRACT TRUNCATED AT 250 WORDS)