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Antimicrobial prophylaxis for colorectal surgery

  1. Richard L Nelson1,*,
  2. Ed Gladman2,
  3. Marija Barbateskovic3

Editorial Group: Cochrane Colorectal Cancer Group

Published Online: 9 MAY 2014

Assessed as up-to-date: 3 JUL 2013

DOI: 10.1002/14651858.CD001181.pub4


How to Cite

Nelson RL, Gladman E, Barbateskovic M. Antimicrobial prophylaxis for colorectal surgery. Cochrane Database of Systematic Reviews 2014, Issue 5. Art. No.: CD001181. DOI: 10.1002/14651858.CD001181.pub4.

Author Information

  1. 1

    Northern General Hospital, Department of General Surgery, Sheffield, Yorkshire, UK

  2. 2

    Northern General Hospital, Department of Surgery, Sheffield, S5 7AU, UK

  3. 3

    Bispebjerg Hospital, Cochrane Colorectal Cancer Group, Copenhagen, Denmark

*Richard L Nelson, Department of General Surgery, Northern General Hospital, Herries Road, Sheffield, Yorkshire, S5 7AU, UK. altohorn@btinternet.com. Rick.Nelson@sth.nhs.uk.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 9 MAY 2014

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Summary of findings    [Explanations]

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Differences between protocol and review
  19. Notes
  20. Index terms

 
Summary of findings for the main comparison. Antibiotic versus no antibiotic/placebo for colorectal surgery

Antibiotic versus no antibiotic/placebo for colorectal surgery

Patient or population: patients undergoing colorectal surgery
Settings:
Intervention: antibiotic versus no antibiotic/placebo

OutcomesIllustrative comparative risks* (95% CI)Relative effect
(95% CI)
No of participants
(studies)
Quality of the evidence
(GRADE)
Comments

Assumed riskCorresponding risk

ControlAntibiotic versus no antibiotic/placebo

Surgical wound infection (SWI)Study populationRR 0.34
(0.28 to 0.41)
2455
(30 studies)
⊕⊕⊕⊕
high1

368 per 1000125 per 1000
(103 to 151)

Moderate

391 per 1000133 per 1000
(109 to 160)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

 1We consider our results not to be affected by either post-randomisation attrition or clinical heterogeneity.

 Summary of findings 2 Combined oral and intravenous compared to oral or intravenous alone for colorectal surgery

 

Background

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Differences between protocol and review
  19. Notes
  20. Index terms

Abdominal surgical wound infections in patients having operations on the large intestine occur in about 40% of those who do not receive antibiotic prophylaxis (Baum 1981). When an infection does occur, it often involves more than simple drainage of subcutaneous pus and dressing changes at home. Indeed, the risk of death is doubled , intensive care unit admission is more likely and average hospital stay is lengthened by five days (Kirkland 1999). In patients with surgical wound infection, length of stay is one week longer and hospital cost averages USD 13,746 more than in those without infection (USD 2,009 Mahmoud 2009) and an average of USD 6,200 in home care costs are incurred after discharge (USD 2,004, Smith 2004). The risk of hospital readmission is also greatly increased (Kirkland 1999). Contrary to traditional beliefs about pus being a good sign, it seems that survival rates in patients who have colon cancer removed are reduced when wound infection has occurred (Nespoli 2004), though the reasons for this are unknown. Reducing the risk of surgical wound infection is clearly a priority in terms of patient safety and cost containment of medical care.

In 1981, an early systematic review that compared wound infection risk in elective colorectal surgery patients receiving antibiotic prophylaxis to those randomised to placebo or no treatment found that infection risk was so diminished with antibiotics that the review concluded that future studies in this field that included no treatment controls would no longer be ethical (Baum 1981). It was also stated that a gold-standard antibiotic should be established, so that in all future studies one arm of the study would include the gold standard as the acceptable benchmark from which to judge the new antibiotic. Since then, guidelines have been published that suggest an optimal choice of antibiotic and also dosage regimens (Medical Letter 2012). However, a survey of American hospitals found that these guidelines are followed approximately half of the time (Bratzler 2005).

Published summaries of evidence are found in a number of systematic reviews. The first, cited above, dealt only with any antibiotic versus no treatment controls (Baum 1981). Another looked only at one aspect of route of administration: oral plus intravenous antibiotics versus intravenous antibiotics alone (Lewis 2002), as did Bellows 2011. A fourth was a global review of studies published from 1984 to 1997, but focused more on individual comparisons rather than the global issues mentioned above (Song 1998). This is just a sample of many other such reviews. This systematic review was undertaken in order to determine whether evidence exists to reconfirm the need for antibiotic prophylaxis, to determine what spectrum of bacteria needs to be addressed by the choice of antibiotic (e.g. Gram-negative versus Gram-positive bacteria), to determine the best timing and route of antibiotic administration and, finally, to see whether any antibiotic performs better than the gold standard currently recommended in published guidelines.

 

Objectives

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Differences between protocol and review
  19. Notes
  20. Index terms

This systematic review has been undertaken to assess the relevant literature in order to establish the effectiveness of antimicrobial prophylaxis in patients undergoing colorectal surgery for the prevention of surgical wound infection.

The review addresses the following questions:

  1. Does antibiotic prophylaxis diminish the risk of surgical wound infection in colorectal surgery?
  2. What spectrum of bacteria (aerobes or anaerobes) needs to be addressed by antibiotic choice?
  3. What is the best timing of antibiotic administration and, specifically, should antibiotics be continued into the postoperative period?
  4. What route of antibiotic administration (intravenous, oral or both) is most effective in preventing surgical wound infection?
  5. Does any antibiotic choice exceed the efficacy of the currently recommended gold-standard prophylactic antibiotic therapy? (For definitions see 'Methods of the review').
  6. Should antibiotics be given before or after surgery?

 

Methods

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Differences between protocol and review
  19. Notes
  20. Index terms
 

Criteria for considering studies for this review

 

Types of studies

Randomised controlled trials that assess the effectiveness of antimicrobial prophylaxis in the prevention of postoperative surgical wound infections in patients undergoing colorectal surgery.

 

Types of participants

Patients (adults and children) undergoing either elective or emergency colorectal surgery, in which sepsis was not suspected preoperatively. This might include bowel obstruction without perforation . We found no trial that included children.

 

Types of interventions

We considered all antimicrobial prophylaxis regimens delivered orally, intravenously or by intramuscular injection used to prevent postoperative infection. Antibiotics had to be administered before the onset of infection and studies in which antibiotics were given before surgery for suspected appendicitis or diverticulitis were excluded because the antibiotics are treating an established infection for which surgery is required. Administration of antibiotics by other means, notably topically, were excluded as they will be the topic of a separate systematic review.

 

Types of outcome measures

The abdominal wound has the greatest risk of infection; most commonly from contamination by endogenous colorectal bacteria (contained within the patient's bowel) during surgical procedures (Pollock 1987). In this review, therefore, the rate of surgical wound infection was used as the primary and sole outcome measure to assess the relative effectiveness of antimicrobial prophylaxis in colorectal surgery. The definition and diagnosis of surgical wound infections often varies between published studies, but has the common feature of pus expressed from the surgical incision. We included only abdominal wound infections, because they are more reliably identified than, for example, perineal infections.

 

Search methods for identification of studies

For the original review published in 2009 (Nelson 2009) we searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE (Ovid) and EMBASE (Ovid).

For the update of this review we rewrote the search strategies and extended the searches to cover from 1954 for MEDLINE and 1974 for EMBASE to 7 January 2013. We searched CENTRAL on the same date (Issue 12, 2012) (see Appendix 1). We broadened the search for this update to go backwards to 1954/1974 as well as to extend to 7 January 2013 because of the concern that earlier searches missed studies(always a possibility, but significantly so).

We also searched the references of the identified trials to identify further relevant trials.

 

Data collection and analysis

 

Quality assessment

Due to the large number of studies published in this area, once the decision had been made to include a study, the methodological quality (validity) of the study was assessed by one review author (AMG or FS for the original 1998 review and RN for this update) and checked by another (AMG or FS for the original review and AMG for initial publication of this review in 2009, by RN for this update), using the following check-points:

  • Was the assignment to the treatment groups really random (versus quasi-randomised by birth dates or hospital numbers etc.)? All studies are specified as randomised trials. If the randomisation method was specified and appropriate, we classified it as low risk of bias. If birth date or hospital number was used, then we classified it as high risk of bias. If it was unspecified, which was by far the greatest likelihood, we classified it as unclear risk of bias.
  • Were those assessing outcomes blind to the treatment allocation? We classified this as low risk of bias if blinding was specified; more commonly we classified this as unclear risk of bias as it was rarely specified.
  • Were the control and treatment groups comparable at entry, i.e. were there significant differences in clinical parameters such as age/gender/diagnosis?
  • Were the groups treated identically, other than for the named interventions?
  • Were the operative procedures defined and described?
  • Was a written definition of wound infection and other outcome measures included?
  • Was relatively complete follow-up achieved (i.e. greater than 90%)?
  • Were the outcomes of people who withdrew described and included in the analysis?
  • Was the outcome assessor blind as to treatment group. When this was not specified we assumed that the surgical team did the outcome assessment and that there was a high risk of bias.

We resolved any disagreements arising at this stage by discussion.

 

Data abstraction

Data were extracted from included trials by one review author and checked by another using a data abstraction form (Appendix 2).

 

Data synthesis

We grouped studies according to the following comparisons:

  • Antimicrobial prophylaxis versus no treatment control or placebo.
  • Short- versus long-term use of an antimicrobial (either alone or in combination). A subgroup analysis included patients who received only a single preoperative dose versus those who received at least a second intraoperative dose of antibiotic or postoperative dosing (or both).
  • Any antimicrobial prophylaxis regimen with added aerobic bacterial coverage versus same regimen with no additional aerobic coverage.
  • Any antimicrobial prophylaxis regimen with added anaerobic bacterial coverage versus same regimen with no additional anaerobic coverage.

In most cases of the third and fourth comparisons above, the primary (non-test) antibiotic did not have a bacterial coverage spectrum that might overlap with the test antibiotic.

  • Aerobic bacterial coverage only versus anaerobic bacterial coverage only.
  • Antimicrobial prophylaxis administered orally only versus intravenously only.
  • Combined oral and intravenous antibiotic prophylaxis versus either oral or intravenous antibiotic prophylaxis alone.
  • Antibiotic given before surgery versus after surgery.
  • Comparison of any antibiotic therapy to an established gold-standard antibiotic prophylaxis regimen. This is in accordance with the recommendation of Baum 1981, that once the efficacy of any antibiotic prophylaxis had been established - as it had been in 1980, when compared to placebo - then all future antibiotic trials should consist of comparisons of trial antibiotics to those gold standards (i.e. those antibiotics in common clinical use, as recommended by widely accepted published clinical guidelines), to see whether any new antibiotic regimen clearly exceeded the efficacy of widely recommended choices and might, therefore, be worthy of further study. Alternatively, where the efficacy of any regimen was much worse than the established choices, such that it should not be recommended for use in future.

The gold standards used in these comparisons included:

We examined heterogeneity firstly by examining the characteristics in the Characteristics of included studies table. We assessed statistical heterogeneity using the Chi2 test (P value less than 0.1) and by assessing the I2 statistic (significant if > 30%). This describes the percentage of the variability in effect estimates that is due to heterogeneity rather than chance). Where heterogeneity existed, we investigated by subgroup analysis.

We used the random-effects method throughout this review because even in the absence of statistical heterogeneity, there was such broad clinical heterogeneity in the included studies (such as 19 different antibiotics used in the 30 placebo based trials) ( Analysis 1.1).

Dichotomous outcomes (e.g. surgical wound infection present or not) are presented as risk ratios (RR) with 95% confidence intervals (CI).

 

Results

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Differences between protocol and review
  19. Notes
  20. Index terms
 

Description of studies

The prior published review included a total of 182 trials, published between January 1980 and December 2007, and included 30,880 patients. Studies added in this update bring the total to 260 included studies with 43,451 participating patients. We reclassified nine studies from the original 2009 review as excluded, by far the most common reason being that they involved topical antimicrobial therapy, which will be the subject of a separate review. Thus 87 studies were added in this update.

A total of 68 different antibiotics have been assessed in the included studies; 24 were cephalosporins, the antibiotics thought to have most risk of causing Clostridium difficile colitis (Nelson 2011). Ninety-six studies were excluded from the review for reasons outlined in the Characteristics of excluded studies table. Seventeen of the included trials were published in German, nine in French, two each in Danish and Italian and one each in Chinese, Finnish, Japanese, Korean, Portuguese and Spanish. All other trials were published in English. Full details of the participants, interventions and outcomes assessed are presented in the Characteristics of included studies table.

 

Risk of bias in included studies

The biggest risk of bias in this review is attrition. Many patients were excluded from analysis after randomisation. This was not due to loss to follow-up, since these patients were in hospital recovering from a major operation. However, if a patient had their surgery cancelled, was found to have an intra-abdominal infection such as ruptured diverticulitis, or if study drugs were delivered off schedule or in error, the follow-up of that patient ceased rather than continued to the outcome endpoint. At the time that these studies were performed, there was clearly an essential misunderstanding of what was meant by randomisation. Rates of attrition varied from 0% to nearly 50% (Hagen 1980). In most cases where there were post-randomisation exclusions, it was not specified to which group the exclusions belonged. Therefore all of these studies are analysed as treated. We established a threshold of 10% attrition and in the 'Risk of bias' figures (Figure 1; Figure 2) in the third column (attrition bias) green indicates less than 10% attrition and red any percentage over 10%.

 FigureFigure 1. 'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
 FigureFigure 2. 'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

If a valid method of randomisation was specified the Figure 1 allocation sequence column is shown as green. If it was known that an invalid method of randomisation was used, such as birth date or hospital number, then it is shown as red. However, by far the most common finding was that although the text stated that patients were randomised, the method was not specified and we therefore classified the study as unclear; this appears in Figure 1 as an amber question mark. Allocation concealment was similarly rarely specified. In such situations we also classified it as unclear (so amber). On the other hand, if blinding of the outcome assessor was not specified then clinical experience suggests that the surgical team did the outcome assessment. Therefore, if blinding was specified it shows in the figures as green and in all other situations as red.

 

Antimicrobial prophylaxis versus no treatment control/placebo

Thirty trials (2435 patients), published between 1971 and 2009, were identified that compared some form of antimicrobial prophylaxis and either no treatment or placebo. In only nine trials was the method of randomisation specified. Blind outcome assessment was undertaken in 13/30 trials and attrition of less than 10% was seen in 20/30 trials ( Analysis 1.1; Figure 1).

 

Short- versus long-term use of an antimicrobial

Thirty-three trials (4988 patients) examined variation in the duration of the antimicrobial regimen. The trials were published between 1978 and 2011.  Analysis 2.1 contains all trials in which two different durations are specified, one short and the other longer. Of these 33 trials, 10 specified a valid allocation sequence, 17 trials had attrition of less than 10% and eight specified blinding of outcome assessment (Figure 1)

 

Antimicrobial prophylaxis regimen with additional aerobic coverage versus same regimen with no additional aerobic coverage

Fifteen trials (1869 patients) examined the effectiveness of additional aerobic cover. The trials were published between 1980 and 1986. Six of these trials specified the allocation sequence generation, eight had attrition of less than 10% and nine specified blinding of outcome assessment (; Figure 1). In all of these trials the non-variable antibiotic was one with a purely anaerobic spectrum of bacterial sensitivity and of course the test antibiotic had an aerobic spectrum. This is therefore a pure test of the need for aerobic coverage, in contrast to  Analysis 4.1 in which the non-variable antibiotic(s) might have had both aerobic and anaerobic spectra and in those situations the test antibiotic only augmented the anaerobic coverage.

 

Antimicrobial prophylaxis regimen with additional anaerobic coverage versus same regimen with no additional anaerobic coverage

Eighteen trials (2625 patients), published between 1977 and 1993, examined the effectiveness of additional anaerobic cover. Seven of these studies specified the allocation generation sequence. Seven had attrition of less than 10% and 10 specified blinding of outcome assessment (; Figure 1).

 

Antimicrobial prophylaxis regimen with only aerobic coverage versus a regimen with only anaerobic coverage

This is a new comparison treating patients with antibiotics active only against aerobic bacteria versus an antibiotic active only against anaerobic bacteria. There are four studies in this analysis studying 546 patients. Only one study described an adequate randomisation sequence and the same study also had blinding of the outcome assessment (Figure 1). The other three studies all had attrition of less than 10%.

 

Antimicrobial prophylaxis administered orally versus intravenous administration

Three trials (237 patients) compared the effectiveness of the same antibiotics given by different routes of administration . Only one trial had an adequate randomisation method and another had blinding of outcome assessment. All three had attrition of less than 10% (Figure 1).

 

Antimicrobial prophylaxis administered orally and intravenously versus intravenously alone

Fourteen reports (2445 patients) assessed combined oral and intravenous prophylaxis versus intravenous alone. In no case was the same antibiotic used for both routes of administration as it had been in the previous section. Seven studies used adequate randomisation and four used adequate concealment of outcome assessment. Five studies had drop-out rates of 10% or greater (Figure 1). The reported drop-out (attrition) rate was as high as 34% (Khubchandani 1989).

 

Antibiotic prophylaxis delivered orally and intravenously versus orally alone

Ten studies (2364 patients) compared antibiotic prophylaxis in this manner ( Analysis 7.2) published between 1979 and 2007. Randomisation method was specified in four trials and outcome blinding was specified in four trials as well. Attrition was less than 10% in six trials (Figure 1).

 

Antibiotic prophylaxis delivered before or after surgery

Only two studies gave the same antibiotic either before or after surgery (127 patients). Neither study adequately described randomisation or blinding of outcome assessment. Only one had attrition of less than 10% ( Figure 1).

 

Antibiotic prophylaxis of any antibiotic compared to an established gold-standard prophylaxis regimen

There are several antibiotic regimens that are so broadly used as to be regarded as gold standards to which other antibiotic choices should be compared, recommended in guidelines cited in the Background. These include oral neomycin/erythromycin base, intravenous cefoxitin or cefotetan and, formerly, intravenous doxycycline. Forty-three trials (6492 patients) included such comparisons. Twelve of these trials had adequate randomisation, only eight specified blinding of outcome assessment and 19 had attrition of less than 10%. However, these studies are meant only to be viewed individually, to see if an outlier might be better than any of the gold standards (see below).

 

Effects of interventions

See:  Summary of findings for the main comparison Antibiotic versus no antibiotic/placebo for colorectal surgery;  Summary of findings 2 Combined oral and intravenous compared to oral or intravenous alone for colorectal surgery

Many studies had results that could not provide useful clinical direction because two or more of the study groups contained multiple variables (i.e. variations in the type of antibiotic, dosing schedule and route of administration), which made it impossible to determine which of these three factors might have been responsible for any difference in results. Other studies employed antibiotic combinations that were neither compared to established techniques of prophylaxis, nor offered a rational approach to prophylaxis based upon what is known about colonic bacterial flora and the nature of surgical wound infection in colorectal surgery. Thus in the initial review, 76 studies, though eligible by our inclusion criteria, ultimately were not used in any of the meta-analyses. The remaining 106 studies that included a total of 15,859 participants were included in the analysis. In this first update this was less of a problem, with 79 of the 260 studies included in the meta-analyses. The total number of participants now included in the meta-analyses is 25,314.

 

Antimicrobial prophylaxis versus no treatment control/placebo (Comparison 01)

Despite the recommendations of Baum 1981 that no further trials of antimicrobials versus placebo be performed, an additional 20 placebo-controlled trials have been published since 1981, the last in 2009 (Sato 2009). The combined analysis of 30 randomised controlled trials (RCTs) involving 2435 participants showed a statistically significant benefit in favour of antibiotic prophylaxis (risk ratio (RR) 0.34, 95% confidence interval (CI) 0.28 to 0.41; P value less than 0.00001), reducing the overall surgical wound infection rate from 39% to 10%, with no statistical heterogeneity (P value 0.24; I2 = 15%;  Analysis 1.1; Summary of findings table 1). Since Baum 1981, it is worth noting that no study effect falls to the right of 1.0 in the forest plot and each individual study either shows a statistically significant benefit of prophylaxis or a benefit that is nearly significant. This shows that the question of whether antimicrobial prophylaxis is better than no treatment, a control or placebo for colorectal surgery does not need to be asked again. Despite the absence of statistical heterogeneity, these studies are clinically extremely heterogeneous. Nineteen different antibiotics were assessed in these trials.

 

Short- versus long-term use of an antimicrobial (Comparison 02)

Duration of antibiotic dosing was studied in a number of formats and the combined analysis showed no advantage with longer dosing (RR 1.10, 95% CI 0.93 to 1.30; P value 0.26) ( Analysis 2.1), with no heterogeneity (P value 0.65; I2 = 0%). In a subgroup analysis, nine studies that specifically compared a single preoperative dose of antibiotic to either a second intraoperative dose, or early postoperative dose, or both, also showed no advantage with extended dosing (RR 1.30, 95% CI 0.81 to 2.10; P value 0.58) ( Analysis 2.2). This addresses a specific recommendation that an antibiotic with a short serum half-life should be given with a second dose in longer operations (Medical Letter 2012). The heterogeneity found in this subgroup analysis again was not seen in the broader analysis, which is curious. These eleven trials come from ten publications, since two of the trials come from a single publication, Kow 1995 and Kow 1995a. This multiple trials in a single publication occurs in several other studies: Anders 1984; Anders 1984a; Anders 1984b, Corman 1993; Corman 1993 A, McArdle 1995; McArdle 1995 A, and Menzel 1993; Menzel 1993 A.

Of the 11 trials which contain 2005 patients, five specified valid allocation sequence generation, six had attrition of less than 10% and three had blinded outcome assessment. The statistical heterogeneity in this second comparison (P = 0.11) which disappears if the study Fujita 2007 is eliminated (P = 0.53) and the risk ratio changes from 1.21 (95% CI 0.82 to 1.80) to 1.06 (95% CI 0.77 to 1.45). Fujita 2007 (Fujita 2007) is a large study and reasonably well conducted. The antibiotic used was cefmetazole, a second-generation cephalosporin used principally against Staphylococcus, an aerobic organism not generally found in the bowel, nor therefore the usual infecting agent after bowel surgery, which are bacteria found in the lumen of the bowel (Medical Letter 2012). In other words clinically this study is very much an outlier due to an inappropriate antibiotic choice.

 

Antimicrobial prophylaxis regimen with additional aerobic coverage versus same regimen with no additional aerobic coverage (Comparison 03)

In patients receiving an antibiotic that principally covered anaerobic bacteria, the addition of an antibiotic that covered aerobic bacteria significantly reduced the incidence of surgical wound infection (RR 0.44, 95% CI 0.29 to 0.68; P value 0.0002), with only modest statistical heterogeneity (P value 0.11; I2 = 32%) ( Analysis 3.1). The study with the greatest effect on this heterogeneity is Kläy 1983, though review of its conduct reveals no specific cause other than an overall low wound infection rate.

 

Antimicrobial prophylaxis regimen with additional anaerobic coverage versus same regimen with no additional anaerobic coverage (Comparison 04)

The addition of anaerobic coverage to aerobic coverage also resulted in a statistically significant reduction in surgical wound infection rates (RR 0.47, 95% CI 0.31 to 0.71; P value 0.0004), but in this case with significant statistical heterogeneity (P value 0.0003; I2 = 55%,  Analysis 4.1). Most of the studies for the non-variable antibiotic used a single drug with a principally aerobic spectrum. This analysis also contained significant statistical heterogeneity (P = 0.0003). Many of the studies were of questionable quality due to uncertain randomisation and low power, though no single study stood out in this regard. Eliminating the most skewed studies reduced heterogeneity, but no single elimination was effective in this respect. In four of the studies in this group the constant antibiotic, which was meant to have an aerobic spectrum, also had some anaerobic activity, which differs from  Analysis 3.1 (Bergman 1987; Hall 1989b; Renner 1989; Tehan 1989). Elimination of these studies from the analysis (not shown) diminished heterogeneity, but not to an insignificant level.

 

Antimicrobial prophylaxis using antibiotic with aerobic coverage only versus anaerobic coverage only (Comparison 5)

This comparison of four studies did not demonstrate superiority of aerobic over anaerobic coverage (RR 0.84, 95% CI 0.30 to 2.36). The investigation of heterogeneity in this comparison suggested a poor aerobic antibiotic choice by Lewis 1981. If this study is excluded the heterogeneity disappears and the benefit of aerobic coverage is of borderline statistical significance (RR 0.56, 95% CI 0.30 to 1.06) ( Analysis 5.1). The aerobic coverage in Lewis 1981 came from cephradine, a first-generation cephalosporin with aerobic Gram-positive coverage, principally for skin and respiratory infections, so like the outlier in ( Analysis 2.2) there was clinical heerogeneity due to inaapropriate antibiotic choice.

 

Antimicrobial prophylaxis administered orally versus intravenous administration (Comparison 06)

Three studies looked at the same antibiotic delivered either intravenously or by mouth without demonstrable advantage of either route alone (RR 2.31, 95% CI 0.60 to 8.83; P = 0.22) ( Analysis 6.1).

 

Antimicrobial prophylaxis administered both orally and intravenously versus intravenous prophylaxis alone (Comparison 07.1)

A statistically significant benefit in favour of combined oral and intravenous dosing, compared to intravenous dosing alone, was shown (RR 0.55, 95% CI 0.43 to 0.71; P = 0.0001) ( Analysis 7.1; Summary of findings table 2).

 

Antimicrobial prophylaxis administered both orally and intravenously versus oral prophylaxis alone (Comparison 07.2)

Again, a statistically significant benefit was shown for combined oral and intravenous dosing, compared to oral prophylaxis alone (RR 0.52, 95% CI 0.35 to 0.76; P = 0.0003) ( Analysis 7.2; Summary of findings table 3).

 

Antimicrobial prophylaxis given before surgery or immediately afterward (Comparison 8)

Two studies gave the same antibiotic just before or just after surgery. No advantage was seen in the comparison (RR 0.67, 95% CI 0.21 to 2.15; P = 0.5) ( Analysis 8.1).

 

Antibiotic choice versus a published gold standard (Comparison 09)

There is no combined analysis for these 43 studies as the purpose here, unlike the other comparisons, was to look for outliers on the right or left of the forest plot. Several stand out: Antonelli 1985 compared two cephalosporins that did not differ significantly in other studies (Jones 1987b). Weaver 1986 and Kling 1989 compared intravenous ceftriaxone and metronidazole to oral neomycin and erythromycin with apparent significant benefit, though other ceftriaxone studies were not so striking (Burdon 1987; Garcia 1989; Hall 1991; Nyam 1995; Zanella 2000), especially when this was compared to other intravenous choices. Also, Schoetz 1990 showed a significant benefit to oral plus intravenous dosing of two established gold-standard regimens (Medical Letter 2012), intravenous cefoxitin and oral neomycin/erythromycin base, compared to each one alone. Itani 2006 compared ertapenem to cefotetan and found a significant benefit with the former, though no real intention-to-treat analysis was performed in this large multicentre study and the per protocol analyses presented included only 63% of those randomised. Importantly, this is the only study to report subsequent infection with Clostridium difficile. Eight patients who received ertapenem acquired C. difficile, together with three from the cefotetan group ( Analysis 9.1).

 

Sensitivity analyses

We undertook several sensitivity analyses, in addition to the two described above, to isolate those studies in each section which were, apparently, of higher quality because of a specified method of randomisation, blinding of outcome assessment and low drop-out rate. This eliminated over 90% of the included studies and left either one or two studies in each general category for analysis. Power was, of course, diminished, but no conclusions were reversed markedly, though for comparisons  Analysis 3.1 and  Analysis 4.1 statistical significance disappeared due to small sample sizes.

In no case was the summary assessment of these sensitivity analyses significantly altered from the broader analyses. For studies testing comparisons to gold-standard options, only one showed a significant benefit (Schoetz 1990), which in fact compared two gold-standard options combined with each individually, essentially strengthening the efficacy of combined intravenous/oral prophylaxis.

 

Discussion

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Differences between protocol and review
  19. Notes
  20. Index terms
 

Summary of main results

This is an update of the first published version of this review in The Cochrane Library 2009, Issue 1 (Nelson 2009). Our review shows that:

  • antibiotics given before elective or emergency colorectal surgery reduce wound infections;
  • there is insufficient evidence to support the use of more than a single preoperative dose. Prolonged dosing both increases the risk of development of resistant bacteria and Clostridium difficile colitis (Nelson 2011).
  • evidence from the analysis in this review indicates that antibiotic choice should include aerobic bacterial coverage.
  • In addition antibiotic choice should include coverage of anaerobic bacteria. Evidence from these analyses show that coverage of both types of bacteria either with a single agent or combination therapy is more effective than coverage of either aerobic or anaerobic bacteria alone in reducing wound infection
  • both oral and intravenous administration of antibiotics substantially reduce wound infections compared with no antibiotic.

It appears that a combination of both routes of administration will result in the greatest decrease in risk. This raises a quandary since bowel cleansing prior to surgery is not recommended (Guenaga 2011) and the effectiveness of oral antibiotics in an uncleansed colon is not known (see below). No new antibiotic has appeared that warrants further investigation. Among those discussed above, ertapenem provided benefit but in a flawed study (Itani 2006). There is only weak and inconclusive evidence from two small studies which have compared antibiotic administration before or after surgery. That is an important point but one that is not likely to be subjected to a fair test again, i.e., prophylaxis has meant throughout the last 50 years antibiotics given before the surgery starts, before the colon is opened. And it has been found to be effective. Would prophylaxis given immediately after surgery but before infection occurs be as effective?

 

Overall completeness and applicability of evidence

This systematic review includes 260 randomised controlled trials (RCTs) with 43,451 patients and 68 different antibiotics, including 24 cephalosporins. At first glance it would appear that our goal should be to find the one antibiotic that provides the best outcome for elective colorectal surgery. In the earlier versions of this review it became apparent that a seemingly endless progression of individual comparisons would not lead to that desired result (Song 1998). Many of the RCTs included multiple variables between comparison groups - for instance varying antibiotic type, route of administration, timing and duration of dosage - making a simple interpretation of their results regarding antibiotic preference, as well as comparability to other studies impossible. Apparently, many other studies were performed for the purpose of demonstrating that a particular antibiotic was 'as good as' an existing approved antibiotic for prophylaxis, thus justifying similar regulatory approval for the new antibiotic. Therefore, out of the 260 studies, only 181 trials encompassing 25,314 patients are included in the combined analyses. In most of the studies included in this review pre-operative cleansing of the colon was undertaken routinely and the more recent avoidance of this part of the pre-operative routine casts some uncertainty over the applicability of the findings to current clinical practice.

Also, it was suggested, even by the first systematic reviews in this field (Baum 1981), that meta-analysis of multiple different antibiotics when compared to placebo would yield a homogeneous result, i.e. that the individual antibiotic choice may not be nearly as important as the fact that some antibiotic be used, and that timing, coverage and duration are the most important variables. So our goal in this systematic review turned out to be not to name a single antibiotic for prophylaxis, but to re-establish the principle of antibiotic prophylaxis, and to determine the best timing, duration, route of administration and overall bacterial coverage that should be used in antibiotic prophylaxis for elective colorectal surgery.

Attention must be paid to antibiotic specificity. The required spectrum of coverage in colorectal surgery is determined by the flora found within the patient's large bowel. This is a copious mixture of both anaerobic and aerobic species (Baeckhed 2005) rather than introduction of contaminants from the patient's skin or the operating room team (Gorbach 1991), so antibiotic choices that cover both anaerobic and aerobic bacteria gave the best results.

This is a large systematic review. It could have been much larger if we had chosen to pursue analysis of all reported outcomes, from those that might have much more to do with surgical technique such as anastomotic or fascial dehiscence, or patient-related factors such as infections of the lungs or urinary bladder. Instead we focused on a single outcome, which was infection of the abdominal surgical wound. It can be seen from data cited in the Background section that much of what can go wrong in colorectal surgery is due to or associated with infection at this site (Kirkland 1999; Nespoli 2004). Surgical wound infection is reported as an outcome in virtually every antibiotic trial, since the stated purpose of antibiotic prophylaxis is to reduce this incidence. Other outcomes are reported with much less frequency, and also much less precision as they are harder to detect and lack commonly used definitions such as the Centers for Disease Control (CDC) guidelines on infection. In other meta-analyses, it has been found that inclusion of infectious outcomes that are anatomically distant, or more broadly defined, introduces significant heterogeneity into the analyses and makes calculation of a summary statistic inadvisable (Nelson 2003). Heterogeneity was rare in our calculations.

Baum made three recommendations at the end of his classic report (Baum 1981). Firstly, that it was unethical to perform subsequent studies of antibiotic prophylaxis in colorectal surgery in which the control group received no treatment. Despite this, there have been nine such studies since (see  Analysis 1.1). Secondly, in order to keep some organisation in the field, all subsequent studies should measure some factor (antibiotic choice, dose, timing, route) against an established guideline, so that narrowing of the field could take place. This has rarely been done. Of the 260 RCTs included here, 43 made such comparisons but 79 contained pairings that made no clinical sense, or contained so many variables between the two treatment groups that no specific conclusions could be drawn from the results. Thirdly, that the best prophylactic drugs might be 'fringe' antibiotics, i.e. ones that would not be used as a first-line choice in the treatment of surgical infection. Oral neomycin/erythromycin base fulfilled this suggestion well. The prevalent use of cefoxitin, cefotetan or metronidazole does not. These are clearly efficacious, but one must be concerned about the potential for generating bacterial resistance to these important drugs.

The disappearance of doxycycline from clinical practice is curious. It was only reported extensively in the Scandinavian literature, but appeared to be efficacious. It has several advantages over cephalosporins, which are currently the most commonly used antibiotics in surgical prophylaxis. Doxycycline is not an antibiotic commonly used in the treatment of established surgical infection, nor is it prominently associated with causing C. difficile colitis, and it is not expensive. Doxycycline has not been studied extensively in comparison to other established gold-standard antibiotic recommendations, but perhaps it should be.

It is tempting when looking back at so many comparisons to infer a transitive effect, i.e. to conclude that if one antibiotic is better than a second, and the second in turn is better than a third, that the first must be better than the third. There are statistical reasons why such a process is called the transitive fallacy and it should be avoided (Baker 2002).

 

Quality of the evidence

The quality of evidence across the comparisons in this review is high. Our analyses are robust to the exclusion of studies at high risk of attrition and detection bias in terms of both the direction and magnitude of effect. The clinical heterogeneity noted above in terms of the type of surgery and antibiotic used did not translate into substantial statistical heterogeneity. The results of many of the studies in our primary analyses suggest variation more by size rather than direction of effect. We do not consider publication bias or indirectness to impact on our confidence in the results.

 

Agreements and disagreements with other studies or reviews

Other meta-analyses have already been published in this field. Among those that have been informative:

  • one looked at antibiotic prophylaxis versus no treatment (Baum 1981), frequently discussed above;
  • the second looked at route of administration of antibiotics (Lewis 2002);
  • Bellows 2011 also looked at route of administration and also provided useful guidance as to the search strategy for this review;
  • Kujath 1984 provided information about many randomised trials from the 1960s and 1970s;
  • Song 1998 provided a global assessment of all antibiotics in a somewhat narrower period from 1984 to 1997 and was the predecessor of this review.

The Lewis 2002 study focused on the comparison of combined oral and intravenous antibiotic prophylaxis versus intravenous prophylaxis alone. The authors added an additional RCT of their own to previously published studies dating from 1979 to 2002. A significant advantage to combined prophylaxis was found in the combined analysis (P value less than 0.0001). An appropriate assessment of the quality of the included studies was performed based upon that assessment, and no RCTs were excluded. Their analysis included 2065 patients. Our analysis agrees with their findings ( Analysis 7.1). Significant heterogeneity was not present (P value 0.25; I2 = 18.8%) in the Lewis 2002 analyses.

This current systematic review is the first with the purpose of addressing the broader clinical questions, and to suggest a template for future antibiotic assessment. With these findings we can propose the guidelines outlined above and below.

 

Authors' conclusions

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Differences between protocol and review
  19. Notes
  20. Index terms

 

Implications for practice

The evidence summarised in this review confirms that antibiotic prophylaxis reduces infection in people undergoing colorectal surgery.The quality of evidence is sufficiently robust to indicate that further research is unlikely to have any impact on the size of the our pooled effect estimates. It is unethical to operate on a patient, with established or suspected colonic disease, in which the operative field might be exposed to colonic lumenal contents, without preoperative antibiotic dosing.

Despite wide acceptance of intravenous administration of antibiotics one hour before the incision is made, rigorous evaluation to determine the optimum timepoint for antibiotic delivery is lacking. Evidence for the timing of oral antibiotic administration is no less certain, especially in the light of current recommendations against mechanical colon cleansing before surgery (Guenaga 2011), as oral antibiotics have not been studied in the uncleansed colon. Indeed many surgeons continue mechanical cleansing in spite of the evidence in order to give oral antibiotics before surgery (Businger 2011; Englesbe 2010; Krapohl 2011).

There is no need for a second intraoperative dose or any postoperative doses when the antibiotic is being given for prophylaxis alone. Additional dosing may increase the risk of resistant organisms and C. difficile colitis.

This review has found evidence of benefit from antibiotics which offer coverage against both aerobic and anaerobic bacteria. Apart from these points, the actual choice of antibiotic is probably not as important as the timing of administration, timing of cessation and route of administration.

It is likely that combined oral and intravenous prophylaxis will give the best results, but the timing of the oral dosing is unsure, as mentioned above. Since two Cochrane reviews recently challenged the efficacy of mechanical cleansing, related principally to septic risk after surgery, establishing the timing for oral dosing has become even more problematic (Guenaga 2011; Nelson 2003), as it is not known whether oral antibiotics would still be effective when the colon is not empty. This aspect of antibiotic dosing has not been tested.

 
Implications for research

It is unethical to conduct further trials evaluating antimicrobial prophylaxis with a placebo or not treatment control for patients undergoing colorectal surgery.

Future antibiotics that are to be tested need to be compared only to established, commonly recommended drugs.

The number of variables between comparison groups in RCTs needs to be restricted to one, otherwise the results cannot be interpreted.

All RCTs to date have been short-term studies that looked only at their primary outcome and contained little information about adverse events. The adverse effect that causes most concern is the induction of Clostridium difficile pseudomembranous colitis, a potentially lethal complication of antibiotic use (Nelson 2011). Future studies should follow the participants long enough to detect this disease and determine differential risk.

The timing of preoperative antibiotic dosing needs to be assessed in a RCT.

 

Acknowledgements

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Differences between protocol and review
  19. Notes
  20. Index terms

Relating to Song 1998:

Julie Glanville, Information Systems Manager, and Janette Boynton, Assistant Librarian, NHS Centre for Reviews and Dissemination, University of York, York, UK, for assisting with the search and location of the literature for the initial HTA report.

Professor R Freeman, Professor DJ Leaper, Mr EW Taylor, Professor RJC Steele, Dr PG Davey and Professor CS McArdle provided helpful comments on the draft protocol.

Professor MRB Keighley, Mr P McCulloch and Professor A Pollock provided information about their studies.

We are grateful to Professor Trevor Sheldon for his supervision and support during the initial HTA report.

Anne Marie Glenny and Fujian Song were co-authors for the original publication of this review in 2009 but were unavailable for the update.

 

Data and analyses

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Differences between protocol and review
  19. Notes
  20. Index terms
Download statistical data

 
Comparison 1. Antibiotic versus no antibiotic/placebo

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Surgical wound infection (SWI)302455Risk Ratio (M-H, Random, 95% CI)0.34 [0.28, 0.41]

 
Comparison 2. Duration of therapy

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Surgical wound infection (SWI)345123Risk Ratio (M-H, Random, 95% CI)1.10 [0.93, 1.29]

 2 Surgical wound infection (SWI)112005Risk Ratio (M-H, Random, 95% CI)1.21 [0.82, 1.80]

 
Comparison 3. Additional aerobic coverage

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Surgical wound infection (SWI)151869Risk Ratio (M-H, Random, 95% CI)0.44 [0.29, 0.68]

 
Comparison 4. Additional anaerobic coverage

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Surgical wound infection (SWI)192687Risk Ratio (M-H, Random, 95% CI)0.46 [0.30, 0.69]

 
Comparison 5. Aerobic versus anaerobic cover

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Surgical wound infection4546Odds Ratio (M-H, Random, 95% CI)0.84 [0.30, 2.36]

 
Comparison 6. Oral versus intravenous

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Surgical wound infection (SWI)3237Risk Ratio (M-H, Random, 95% CI)2.31 [0.60, 8.83]

 
Comparison 7. Combined oral and intravenous versus oral or intravenous alone

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Surgical wound infection: oral + iv versus iv alone152929Risk Ratio (M-H, Random, 95% CI)0.55 [0.43, 0.71]

 2 Surgical wound infection: combined oral and iv versus oral alone91880Risk Ratio (M-H, Random, 95% CI)0.52 [0.35, 0.76]

 
Comparison 8. Antibiotic given pre- or postoperatively

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Surgical wound infection2129Odds Ratio (M-H, Random, 95% CI)0.67 [0.21, 2.15]

 
Comparison 9. Antibiotic choice versus a gold standard

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Surgical wound infection (SWI)43Risk Ratio (M-H, Random, 95% CI)Totals not selected

 

Appendices

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Differences between protocol and review
  19. Notes
  20. Index terms
 

Appendix 1. Search strategies

Search based on search strategy from Bellows 2011.

MEDLINE (OVID)

1. exp Surgical Wound Infection/

2. exp Postoperative Complications/

3. exp Bacterial Infections/

4. exp Infection/

5. exp Sepsis/

6. (postoperative complication* or infection* or sepsis).mp.

7. 1 or 2 or 3 or 4 or 5 or 6

8. exp Anti-Infective Agents/

9. exp Anti-Bacterial Agents/

10. (Anti infective or antibiotic* or antimicrobial* or anti bacterial*).mp.

11. exp Colorectal Surgery/

12. exp Colon/

13. exp Rectum/

14. exp Colectomy/

15. exp Colostomy/

16. (colon or rectum or rectal or colorectal or colectomy or colostomy).mp.

17. 8 or 9 or 10

18. 11 or 12 or 13 or 14 or 15 or 16

19. 7 and 17 and 18

20. randomized controlled trial.pt.

21. controlled clinical trial.pt.

22. randomized.ab.

23. placebo.ab.

24. clinical trial.sh.

25. randomly.ab.

26. trial.ti.

27. 20 or 21 or 22 or 23 or 24 or 25 or 26

28. humans.sh.

29. 27 and 28

30. 19 and 29

EMBASE (OVID)

1. exp surgical infection/

2. exp postoperative complication/

3. exp bacterial infection/

4. exp infection/

5. exp sepsis/

6. (postoperative complication* or infection* or sepsis).m_titl.

7. 1 or 2 or 3 or 4 or 5 or 6

8. exp antiinfective agent/

9. exp antibiotic agent/

10. (anti infective or antibiotic* or antimicrobial* or anti bacterial).m_titl.

11. 8 or 9 or 10

12. exp colorectal surgery/

13. exp colon/

14. exp rectum/

15. exp colon resection/

16. exp colostomy/

17. (colon or rectum or rectal or colorectal or colectomy or colostomy).m_titl.

18. 12 or 13 or 14 or 15 or 16 or 17

19. 7 and 11 and 18

20. randomized controlled trial/

21. randomization/

22. controlled study/

23. multicenter study/

24. phase 3 clinical trial/

25. phase 4 clinical trial/

26. double blind procedure/

27. single blind procedure/

28. ((singl* or doubl* or trebl* or tripl*) adj (blind* or mask*)).ti,ab.

29. (random* or cross* over* or factorial* or placebo* or volunteer*).ti,ab.

30. 25 or 22 or 26 or 28 or 21 or 27 or 23 or 20 or 29 or 24

31. "human*".ti,ab.

32. (animal* or nonhuman*).ti,ab.

33. 32 and 31

34. 32 not 33

35. 30 not 34

36. 19 and 35

The Cochrane Library

#1 MeSH descriptor Surgical Wound Infection explode all trees

#2 MeSH descriptor Postoperative Complications explode all trees

#3 MeSH descriptor Bacterial Infections explode all trees

#4 MeSH descriptor Infection explode all trees

#5 MeSH descriptor Sepsis explode all trees

#6 (postoperative complication* or infection* or sepsis):ti,ab,kw

#7 (#1 OR #2 OR #3 OR #4 OR #5 OR #6)

#8 MeSH descriptor Anti-Infective Agents explode all trees

#9 MeSH descriptor Anti-Bacterial Agents explode all trees

#10 (anti infective or antibiotic* or antimicrobial* or anti bacterial*):ti,ab,kw

#11 (#8 OR #9 OR #10)

#12 MeSH descriptor Colorectal Surgery explode all trees

#13 MeSH descriptor Colon explode all trees

#14 MeSH descriptor Rectum explode all trees

#15 MeSH descriptor Colectomy explode all trees

#16 MeSH descriptor Colostomy explode all trees

#17 (colon or rectum or rectal or colorectal or colectomy or colostomy):ti,ab,kw

#18 (#12 OR #13 OR #14 OR #15 OR #16 OR #17)

#19 (#7 AND #11 AND #18)

 

Appendix 2. Data Abstraction Form

ANTIMICROBIAL PROPHYLAXIS IN COLORECTAL SURGERY Ms#_____

Reviewer: ……………………………………………………………………………………….

Study ID (first author, year)……………………………………………………………………...

Source (journal title, year, volume, page numbers) …………..………………………………… …………..………………………………………………………………………………………..

Place of publication JournalBookUnpublished

 

Country of origin…………………………………………………………………….………….

Language of publication ………………………………………………………………………..

Source of funding ……………………………………………………………………………….

 

ELIGIBILITY CRITERIA

Is the study an RCT?YesNoUnclear

 

Does it include patients

undergoing colorectal surgery?YesNoUnclear

Does it examine the effectiveness

of antimicrobial PROPHYLAXIS?Yes NoUnclear

Do the authors report SWIs

as an outcome?YesNoUnclear

(note, if No, to this question but all other

eligibility criteria are met, contact author

to ascertain whether or not information on

SWIs was gathered but not reported in the paper)

Does the study meet the inclusion

criteria?YesNoUnclear

Comments/points for clarification with author …………………………………………………………………………………………………………………………………………………………………………………………………………METHODOLOGY

Generation of allocation sequenceAdequateInadequateUnclear/Not stated

Allocation concealment AdequateUnclear/InadequateNot usednot stated

Outcome assessor blinded YesNoUnclear/ Not possible Not stated

A priori calculation of sample size YesNoUnclear/ Not stated

Clear definition of inclusion/ YesNoUnclear/

exclusion criteria Not stated

Groups comparable at YesNoUnclear/

baseline Not stated

Withdrawal rate < 10% YesNoUnclear/Not stated

Clear explanation of drop-outs YesNoUnclear/

in each treatment group Not stated

Post randomization drop-outsYesNo

Divided by group

Adequate definition of SWI YesNoUnclear/Not stated

 

Aim of study ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

PARTICIPANTS

Number of patients assessed for eligibility ……………………………………………………

Source of recruitment ………………… ……………………………………………………….

Criteria for inclusion ………………… ……………………………………………………. .……………………………………………………………………………………………………

Criteria for exclusion ….………………… …………………………………………………. ……………………………………………………………………………………………………

 

Surgical procedures:colorectalappendicectomybiliary

electiveemergency

Bowel preparation procedure ……………………………………………………………………………………………………

Additional comments………………………………………………………………………………………………………………………………………………………………………………


Group 1Group 2Group 3Group 4

Number of patients randomised

Mean age

Gender



INTERVENTIONS

PurposeSingle vs multiple dose

Same antibiotic, different dose

Different antibiotics, one being a gold standard

Different antibiotics, neither guidelined

Extra antibiotics for aerobic coverage

Extra antibiotics for anaerobic coverage

Oral vs. IV vs. both

Topical

Placebo vs. Ab.

Multiple variables separating intervention groups

Other………………………………………………………………….


Group AGroup BGroup C

Antibiotics used

Dose

Time

Route of

Administration

Duration of administration (hours)



Additional comments

…………………………………………………………………………

OUTCOMES ASSESSED

Definition of SWI …………………………………………………………………………………………………………………………………………………………………………………………………………


Group AGroup BGroup CGroup D

Number of drop-outsNumber of drop-outsNumber of drop-outsNumber of drop-outsNumber of drop-outs



 

Feedback

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Differences between protocol and review
  19. Notes
  20. Index terms
 

Included studies in the comparison of oral treatment alone versus combined treatment, 10 March 2015

 

Summary

I thank Nelson et al. for their thorough review of antimicrobial prophylaxis for colorectal surgery[1]. It proved itself useful in my recent attempt to understand the evidence on oral antibiotic prophylaxis compared to intravenous or combined treatments. My concern is that some of the studies included in the comparison of oral and intravenous antibiotic prophylaxis versus oral alone, should have been omitted. These studies are Becker 1991 [2], Coppa 1998 [3] and Kobayashi 2007 [4]. In my opinion, none of these three studies investigate oral treatment alone.

The aim of Becker was to evaluate “the efficacy of a short perioperative course compared to an extended postoperative course of intravenous antibiotics (cefoxitin) in patients undergoing colectomy with ileoanal anastomosis.” 40 patients “received a mechanical and oral antibiotic bowel preparation and a standard three-dose perioperative course of intravenous cefoxitin. Patients then were randomized to receive intravenous cefoxitin, 1 g every 6 hours, or placebo for 5 days” [2]. Coppa investigated the intervention of giving perioperative parenteral cefoxitin alone or in addition to preoperative oral neomycin and erythromycin [3]. Kobayashi states in their title that the study is a ”Randomized clinical trial comparing intravenous antimicrobial prophylaxis alone with oral and intravenous antimicrobial prophylaxis for the prevention of a surgical site infection in colorectal cancer surgery” [4].

I would be very thankful if the authors could clarify why these studies are included in the comparison of oral treatment alone versus combined treatment.

1. Nelson, R.L., E. Gladman, and M. Barbateskovic, Antimicrobial prophylaxis for colorectal surgery. The Cochrane Library, 2014.

2. Becker, J.M. and D.P. Alexander, Colectomy, mucosal proctectomy, and ileal pouch-anal anastomosis. A prospective trial of optimal antibiotic management. Ann Surg, 1991. 213(3): p. 242-7.

3. Coppa, G.F. and K. Eng, Factors involved in antibiotic selection in elective colon and rectal surgery. Surgery, 1988. 104(5): p. 853-8.

4. Kobayashi, M., et al., Randomized clinical trial comparing intravenous antimicrobial prophylaxis alone with oral and intravenous antimicrobial prophylaxis for the prevention of a surgical site infection in colorectal cancer surgery. Surg Today, 2007. 37(5): p. 383-8.

 

Reply

Dear Dr Rosenlund,

Thank you very much for your email and for pointing out my errors.
I have corrected the numerical/inclusion mistakes in the current version. The Becker 1991 study was a tough one to classify, and with no useful results seemed to do little harm where I placed it. Thus I believe we can publish this corrected version.

all my best wishes, Richard L Nelson, Contact author on this review and Co-ordinating editor of the CCCG.

 

Contributors

Comment forwarded by Dr Ingvild Mathiesen Rosenlund, MD and PhD candidate
Email Address: ingvild.m.rosenlund@uit.no Affiliation: UiT The Arctic University of Norway

Dr Rosenlund forwarded the conflict of interest statement below:
I certify that I have no affiliations with or involvement in any organization or entity with a financial interest in the subject matter of my feedback.

 

What's new

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Differences between protocol and review
  19. Notes
  20. Index terms

Last assessed as up-to-date: 3 July 2013.


DateEventDescription

27 August 2015Feedback has been incorporatedFeedback from Rosenlund Ingvild Mathiesen and reply from contact author Rick Nelson



 

History

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Differences between protocol and review
  19. Notes
  20. Index terms

Protocol first published: Issue 2, 1998
Review first published: Issue 1, 2009


DateEventDescription

3 July 2013New citation required and conclusions have changedSubstantial update, modified conclusions

28 January 2013New search has been performedThis is a large update with 87 new studies. Only a few have been published since the 2009 publication of this review. The older citations arose because when reading newer publications over the past three years, we found that our original searches had missed some studies, perhaps many. The original date limitations of our searches were also illogical and more thorough date inclusion was needed. At the last count we had five new searches, each with discernable differences. The search for the accompanying update had over 1800 hits after deletion of duplicate references already in the review. Getting this review update out in a timely manner meant that more detailed comparison and revision of the searches would need to be our task when preparing the next update.

Protocol changes:

We used random-effects meta-analysis only because even in the absence of statistical heterogeneity in most cases there was significant clinical heterogeneity within each comparison.

All studies of topical forms of therapy have been excluded in order that they can be assessed in a separate review.

Two new comparisons and meta-analyses have been added to the review as a result of studies found on this search:

  • Antibiotic with aerobic bacterial coverage versus antibiotic with anaerobic specificity ( Analysis 5.1).
  • Antibiotic given before or after surgery ( Analysis 8.1).

11 November 2008New citation required and conclusions have changedSubstantive amendment.



 

Contributions of authors

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Differences between protocol and review
  19. Notes
  20. Index terms

FS and AMG conceived the initial review project and published a HTA report in 1998 (Song 1998), as well as a protocol in The Cochrane Library (1998, Issue 2). Study selection and data abstraction were done jointly by both authors at that time. Expansion of the review in time (1980 through to 2007) and organisation of the review into a collection of clinically relevant subgroup analyses was conceived by RN, and the additional study selection was done jointly by RN and AMG. Data abstraction was done by RN and checked by AMG. Data analyses were done by RN and checked by AMG. The protocol was rewritten and the final review written by RN. In this update, extensive work was done on development of search strategies and text procurement by MB. Abstracts were screened for eligibility by RN and EG. Full text of over 220 studies was reviewed, and data abstracted, entered and analysed by RN. The text was written by RN. MB did extensive work in developing search strategies and manuscript location and also gave much practical advice during drafting of the update.

 

Declarations of interest

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Differences between protocol and review
  19. Notes
  20. Index terms

None known.

 

Sources of support

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Differences between protocol and review
  19. Notes
  20. Index terms
 

Internal sources

  • NHS Centre for Reviews and Dissemination, University of York, UK.
  • University of Manchester, UK.

 

External sources

  • NHS Health Technology Assessment Programme, England, UK.
  • NIHR Cochrane Incentive Grant, UK.
    2012

 

Differences between protocol and review

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Differences between protocol and review
  19. Notes
  20. Index terms

None known.

 

Notes

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Differences between protocol and review
  19. Notes
  20. Index terms

This is the first update of the original review published in The Cochrane Library 2009, Issue 1 (Nelson 2009). The history of the review is protracted and more sense can be made of the main text if its history is recounted here.

The protocol on which this review is based is a substantial update of the original protocol entitled Antimicrobial prophylaxis in colorectal surgery, originally hosted by the Cochrane Wounds Group and published for the first time in The Cochrane Library 1998, Issue 2 by AM Glenny and F Song. However, though a complete review was published as a Health Technology Assessment in Great Britain (Song 1998), and also by the same authors in the British Journal of Surgery (Br J Surg 1998 Sep;85(9):1232-41), it was never published in The Cochrane Library. The original protocol was relocated to the Cochrane Colorectal Cancer Group in 2002, when the current contact author (RN) became the corresponding author of the review. A completed review with updated search and structural reorganisation was submitted in 2005, but because of the degree of change and long passage of time, a new protocol was requested by the referees. This was done, submitted, approved and published in 2007 (The Cochrane Library 2007, Issue 4). The completed review was submitted in January 2008 and finally accepted for publication October 2008.

* Indicates the major publication for the study

References

References to studies included in this review

  1. Top of page
  2. Abstract
  3. Summary of findings
  4. Background
  5. Objectives
  6. Methods
  7. Results
  8. Discussion
  9. Authors' conclusions
  10. Acknowledgements
  11. Data and analyses
  12. Appendices
  13. Feedback
  14. What's new
  15. History
  16. Contributions of authors
  17. Declarations of interest
  18. Sources of support
  19. Differences between protocol and review
  20. Notes
  21. Characteristics of studies
  22. References to studies included in this review
  23. References to studies excluded from this review
  24. References to studies awaiting assessment
  25. Additional references
  26. References to other published versions of this review
Aberg 1984 {published data only}
  • Aberg C, Olin B, Oresland T, Lundholm C, Bernander S, Stromberg A, et al. Comparison of metronidazole with doxycycline prophylaxis in elective colorectal surgery. Acta Chirurgica Scandinavica 1984;150:79-83.
Aberg 1991 {published data only}
Aeberhard 1981 {published data only}
  • Aeberhard P, Fluckiger M, Berger J, Novak A. Parenteral antibiotic prophylaxis or oral antimicrobial bowel preparation for colorectal surgery (author's transl). Langenbecks Archiv für Chirurgie 1981;353(4):233-40.
AhChong 1994 {published data only}
  • AhChong K, Yip AWC, Lee FCW, Chiu KM. Comparison of prophylactic ampicillin/sulbactum with gentamicin and metronidazole in elective colorectal surgery: a randomized clinical study. Journal of Hospital Infection 1994;27:149-54.
Akgur 1992 {published data only}
  • Akgur FM, Tanyel FC, Buyukpamukcu N, Hicsonmez A. Prophylactic antibiotics for colostomy closure in children: Short versus long course. Pediatric Surgery International 1992;7(4):279-81.
Ambrose 1983 {published data only}
  • Ambrose NS, Burdon DW, Keighley MR. A prospective randomized trial to compare mezlocillin and metronidazole with cefuroxime and metronidazole as prophylaxis in elective colorectal operations. Journal of Hospital Infection 1983;4(4):375-82.
Ammann 1981 {published data only}
  • Ammann J, Blessing H, Marti WK. Antibiotic prophylaxis in elective colon surgery: comparison of the combination of metronidazole (Flagyl)/cefazolin (Kefzol) with cefazolin alone. Helvetica Chirurgica Acta 1981;48(1-2):235-42.
Andaker 1992 {published data only}
  • Andaker L, Burman LG, Eklund A, Graffner H, Hansson J, Hellberg R, et al. Fosfomycin/metronidazole compared with doxycycline/metronidazole for the prophylaxis of infection after elective colorectal surgery. European Journal of Surgery 1992;158:181-5.
Anders 1984 {published data only}
  • Anders VA, Nordhausen Z, Zeuschner Z, Fabrizius K. Prophylaxis against infections in colonic surgery [Infektionsprophylaxe in der Kolonchirurgie]. Zentralblatt fur Chirurgie 1984;109:1097-106.
Anders 1984a {published data only}
  • Anders VA, Nordhausen Z, Zeuschner Z, Fabrizius K. Prophylaxis against infections in colonic surgery [Infektionsprophylaxe in der Kolonchirurgie]. Zentralblatt fur Chirurgie 1984;109:1097-106.
Anders 1984b {published data only}
  • Anders VA, Nordhausen Z, Zeuschner Z, Fabrizius K. Prophylaxis against infections in colonic surgery [Infektionsprophylaxe in der Kolonchirurgie]. Zentralblatt fur Chirurgie 1984;109:1097-106.
Andersen 1979 {published data only}
  • Andersen SB, Bach-Nielsen P, Balslev I, Frederiksen W. Pre-operative sterilization of the intestine. A controlled double-blind investigation in connection with elective colon-rectum surgery. Ugeskrift for Laeger 1979;141(22):1492-5.
Anonymous 1986 {published data only}
  • Anonymous. Clinical trial of prophylaxis of wound sepsis in elective colorectal surgery comparing ticarcillin with tinidazole. University of Melbourne Colorectal Group. Australian & New Zealand Journal of Surgery 1986;56(3):209-13.
Anonymous 1989 {published data only}
  • Anonymous. A comparison of single-dose systemic Timentin with mezlocillin for prophylaxis of wound infection in elective colorectal surgery. University of Melbourne Colorectal Group. Diseases of the Colon and Rectum 1989;32(11):940-3.
Antonelli 1985 {published data only}
  • Antonelli W, Borgani A, Machella C, Morri F, Parrino A, Poloni M, et al. Comparison of two systematic antibiotics for the prevention of complications in elective colorectal surgery. Italian Journal of Surgical Sciences 1985;15(3):225-58.
Armengaud 1986 {published data only}
  • Armengaud F, Jobard J, Bernard E, Cordero C, Mouiel J, Sicard D, et al. Single dose antibiotic prophylaxis in colorectal surgery: cefoxitine versus piperacillin [French]. La Presse Medicale 1986;15(46):2351-2.
Arnaud 1992 {published data only}
  • Arnaud JP, Bellissant E, Boissel P, Carlet J, Chastang C, Lafaix C, et al. Single-dose amoxycillin-clavulanic acid versus cefotetan for prophylaxis in elective colorectal surgery: a multicentre prospective, randomized study. Journal of Hospital Infection 1992;22(A):23-32.
Athanasiadis 1985 {published data only}
  • Athanasiadis VS, Khulgatz C, Hanel E. Perioperative antibiotic prevention in colon and rectum surgery. A randomized study on the value of single dose prevention [Perioperative antibiotikaprophylax in der kolon - und rektumchirurgie [German]]. Zentralblatt für Chirurgie 1985;110:532-8.
Auger 1987 {published data only}
  • Auger P, Legros G, Girard R, Laverdiere M, Bergeron M, Bourgouin J, et al. Intravenous metronidazole vs oral erythromycin base plus neomycin in the prevention of infection following elective colorectal surgery. Current Therapeutic Research 1987;42(5):922-31.
Barber 1979 {published data only}
  • Barber MS, Hirschberg BC, Rice CL, Atkins CC. Parenteral antibiotics in elective colon surgery? A prospective, controlled clinical study. Surgery 1979;86(1):23-9.
Barker 1971 {published data only}
  • Barker K, Graham NG, Mason MC, De Dombal FT, Goligher JC. The relative significance of preoperative oral antibiotics, mechanical bowel preparation, and preoperative peritoneal contamination in the avoidance of sepsis after radical surgery for ulcerative colitis and Crohn's disease of the large bowel. British Journal of Surgery 1971;58(4):270-3.
Bates 1989 {published data only}
Bates 1992 {published data only}
  • Bates T, Roberts JV, Smith K, German KA. A randomised trial of one versus three doses of Augmentin as wound prophylaxis in at-risk abdominal surgery. Postgraduate Medical Journal 1992;68:811-6.
Becker 1991 {published data only}
Beggs 1982 {published data only}
Bell 1983 {published data only}
Bellantone 1988 {published data only}
  • Bellantone R, Pacelli F, Sofo L, Doglietto GB, Bossola M, Ratto C, et al. Systematic preoperative prophylaxis in elective oncological colorectal surgery: cefotetan versus clindamicin plus aztreonam. Drugs Under Experimental and Clinical Research 1988;14(12):763-6.
Bergman 1987 {published data only}
Bittner 1989 {published data only}
  • Bittner R, Butters M, Rampf W, Kapfer X. Duration of antibiotic prophylaxis in colorectal surgery - one-shot dose vs short-term prophylaxis [German]. Langenbecks Archiv für Chirurgie 1989;374:272-9.
Bjerkeset 1980 {published data only}
Blair 1987 {published data only}
  • Blair JE, McLeod RS, Cohen Z, Devlin HR. Ticarcillin/clavulanic acid (Timetin) compared to metronidazole/netilmicin in preventing postoperative infection after elective colorectal surgery. Canadian Journal of Surgery 1987;30(2):120-3.
Bonzanini 1993 {published data only}
  • Bonzanini C, Ubiali P, Invernizzi R. The use of piperacillin in the preoperative prophylaxis of colorectal surgery [Italian] [L'impiego della piperacillina nella profilassi preoperatoria della chirurgia colorettale]. Minerva Chirurgica 1993;48(23-4):1437-43.
Brass 1978 {published data only}
  • Brass C, Richards GK, Ruedy J, Prentis J, Hinchey EJ. The effect of metronidazole on the incidence of postoperative wound infection in elective colon surgery. American Journal of Surgery 1978;135(1):91-6.
Brolin 1986 {published data only}
  • Brolin J, Lahnborg G, Ljung A, Rietz KA. A comparison between netilmicin with metronidazole and doxycycline as prophylaxis in elective colorectal surgery. Annales Chirurgaie et Gynaecologiae 1986;75:219-24.
Burdon 1987 {published data only}
  • Burdon DW, Keighley MRB. Ceftriaxone and metronidazole as single-dose prophylaxis in colorectal surgery. South African Medical Journal 1987;Suppl 2:15-8.
Burn 1967 {published data only}
  • Burn JI, Sellwood RA, Okubadejo OA, Welbourn RB. Pre-operative bowel sterilisation. Postgraduate Medical Journal 1967;Suppl:17-21.
Cai 1992 {published data only}
  • Cai CJ. Clinical study of prophylactic use of gentamicin and metronidazole in the surgery of colorectal carcinoma [Chinese]. Chinese Journal of Surgery 1992;30(4):237-40.
Cainzos 1986 {published data only}
  • Cainzos M, Potel J, Puente JL. Short-term antibiotic prophylaxis in colorectal surgery: A comparative study of gentamicin plus clindamycin vs cefoxitin. Acta Therapeutica 1986;12:399-412.
Cann 1988 {published data only}
  • Cann KJ, Watkins RM, George C, Rayne-James J, Crawfurd E, Rogers TR. A trial of mezlocillin versus cefuroxime with or without metronidazole for the prevention of wound sepsis after biliary and gastrointestinal surgery. Journal of Hospital Infection 1988;12:207-14.
Carr 1984 {published data only}
  • Carr ND, Hobbiss J, Cade D, Schofield PF. Metronidazole in the prevention of wound sepsis after elective colorectal surgery. Journal of the Royal College of Surgeons of Edinburgh 1984;29(3):139-42.
Claesson 1986 {published data only}
Clarke 1977 {published data only}
  • Clarke JS, Condon RE, Bartlett JG, Gorbach SL, Nichols RL, Ochi S. Preoperative oral antibiotics reduce septic complications of colon operations: results of prospective, randomized, double-blind clinical study. Annals of Surgery 1977;186:251-9.
Colizza 1987 {published data only}
Condon 1983 {published data only}
Coppa 1983 {published data only}
Coppa 1988 {published data only}
Corman 1993 {published data only}
  • Corman ML, Robertson WG, Lewis TH, Odenheimer DB, Zegarra P, Prager ED. A controlled clinical trial: cefuroxime, metronidazole and cefoxitin as prophylactic therapy for colorectal surgery. Complications in Surgery 1993;12(3):37-40.
Corman 1993 A {published data only}
  • Corman ML, Robertson WG, Lewis TH, Odenheimer DB, Zegarra P, Prager ED. A controlled clinical trial: cefuroxime, metronidazole and cefoxitin as prophylactic therapy for colorectal surgery. Complications in Surgery 1993;12(3):37-40.
Cuncliffe 1985 {published data only}
  • Cuncliffe WJ, Carr N, Schofield PF. Prophylactic metronidazole with and without cefuroxime in elective colorectal surgery. Journal of the Royal College of Surgeons of Edinburgh 1985;30(2):123-5.
Cunha 1986 {published data only}
  • Cunha JC, Nery J, Sekiine JH, Deutsch CR, Mittlestaedt WEM, Pires PW, et al. Prophylaxis of infections in colostomy closure surgery. Double blind study with tinidazole [Profilaxia das infeccoes no cirurgia de fechamento de colostomia. Estudio duplo-cego com tinidazole]. Arquivos de Gastroenterologia 1986;23(2):70-5.
Cuthbertson 1983 {published data only}
  • Cuthbertson AM, Ross H, Allsop JR. Clinical trial of prophylaxis of wound sepsis in elective colorectal surgery. Cephamandole with tinidazole versus tinidazole alone. Medical Journal of Australia 1983;2(9):440-3.
Cuthbertson 1991 {published data only}
  • Cuthbertson AM, McLeish AR, Penfold JCB, Ross H. A comparison between single and double dose intravenous Timentin for the prophylaxis of wound infection in elective colorectal surgery. Diseases of the Colon and Rectum 1991;34(2):151-5.
De La Hunt 1986 {published data only}
  • De La Hunt MN, Karran SJ, Chir M. Sulbactam/ampicillin compared with cefoxitin for chemoprophylaxis in elective colorectal surgery. Diseases of the Colon and Rectum 1986;29(3):157-9.
Desaive 1985 {published data only}
  • Desaive C. Use of ticarcillin and/or gentamycin for prophylaxis of infection in colorectal surgery, a randomized study [Utilisation de la ticarcilline et/ou de la gentamicine dans la propylaxie de l'infection en chirurgie recto-colique: etude randomisee [French]]. Acta Therapeutica 1985;11:405-15.
Diamond 1988 {published data only}
  • Diamond T, Mulholland CK, Hanna WA, Parks TG. A prospective randomized trial to compare triple dose mezlocillin with triple dose cefuroxime plus metronidazole as prophylaxis in colorectal surgery. Journal of Hospital Infection 1988;12:215-9.
Diez 1996 {published data only}
  • Diez M, Ruiz-Feliu B, Rodenas E, Noguerales F, Codina A, Macia MA, et al. Single-dose cefminox versus triple-dose cefoxitin as antimicrobial prophylaxis in surgical treatment of patients with colorectal cancer. Current Therapeutic Research, Clinical and Experimental 1996;57(7):559-65.
Dion 1980 {published data only}
  • Dion YM, Richards GK, Prentis JJ, Hinchey EJ. The influence of oral versus parenteral preoperative metronidazole on sepsis following colon surgery. Annals of Surgery 1980;192(3):221-6.
DiPiro 1989 {published data only}
  • DiPiro JT, Welage LS, Levine BA, Wing PE, Stanfield JA, Gaskill HV, et al. Single-dose cefmetazole versus multiple dose cefoxitin for prophylaxis in abdominal surgery. Journal of Antimicrobial Chemotherapy 1989;23(Suppl D):71-7.
Durig 1980 {published data only}
  • Durig M, Neff U, Rittmann WW, Leutenegger A, Oberholzer M, Wolff G. Antibiotic prophylaxis in colon surgery with Cefazolin. Helvetica Chirurgica Acta 1980;46(5-6):721-6.
Edmondson 1983 {published data only}
Espin-Basany 2005 {published data only}
  • Espin-Basany E, Sanchez-Garcia JL, Lopez-Cano M, Lozoya-Trujillo R, Medarde-Ferrer M, Armadans-Gil L, et al. Prospective, randomized study on antibiotic prophylaxis in colorectal surgery. Is it really necessary to use oral antibiotics?. International Journal of Colorectal Disease 2005;20(6):542-6.
Eykyn 1979 {published data only}
Fabian 1984 {published data only}
  • Fabian TC, Mangiante EC, Boldreghini SJ. Prophylactic antibiotics for elective colorectal surgery or operation for obstruction of the small bowel: a comparison of cefonicid and cefoxitin. Reviews of Infectious Diseases 1984;6(4):S896-S900.
Favre 1984 {published data only}
  • Favre JP, Bouchet Y, Clotteau JE, Hypousteguy L, Marchal G, Mercier R, et al. Prophylactic use of cefotaxime in colonic and rectal surgery. Journal of Antimicrobial Chemotherapy 1984;14(B):247-53.
Figueras-Felip 1984 {published data only}
  • Figueras-Felip J, Basilio-Bonet E, Lara-Eisman F, Fava-Bargallo P, Isamat-Baro E, Rosell-Abaurrea F. Oral is superior to systematic antibiotic prophylaxis in operations upon the colon and rectum. Surgery, Gynecology & Obstetrics 1984;158:359-62.
Fingerhut 1993 {published data only}
Fluckiger 1980 {published data only}
  • Fluckiger M, Berger J, Casey P, Aeberhard P. Antibiotic preparation of the colon or preoperative parenteral prophylaxis in colon surgery. A randomized study [German] [Antibiotische Darmvorbereitung oder peroperative parenterale Abschirmung bei Koloneingriffen? Eine randomisierte Studie]. Helvetica Chirurgica Acta 1980; Vol. 47, issue 5:659-62.
Franceshini 1989 {published data only}
  • Franceshini FD, Mastio A, Manzoli D, Mancini P, Rubbo G, Crescioli R. Short-term antimicrobial prophylaxis in colorectal surgery: ceftriaxone vs aztreonam-clindamicin association in randomized studies [Italy]. Chirurgia 1989;42(5):229.
Fry 1993 {published data only}
  • Fry DE, Condon RE, Nichols RL, Smith JW. Single-dose ceftizoxime compared with multiple dose cefoxitin for prophylaxis in elective colorectal operations. Journal of Drug Development, Supplement 1993;6(2):17-9.
Fujita 2007 {published data only}
  • Fujita S, Saito N, Yamada T, Takii Y, Kondo K, Ohue M, et al. Randomized, multicenter trial of antibiotic prophylaxis in elective colorectal surgery: single dose vs 3 doses of a second-generation cephalosporin without metronidazole and oral antibiotics. Archives of Surgery 2007;142(7):657-61.
Garcia 1989 {published data only}
  • Garcia JP, Pedroso JC. Ceftriaxone single dose versus ceftazidime multiple doses in the prophylaxis if infection in colorectal surgery. European Surgical Research 1989;2(1):14-8.
Georgoulis 1983 {published data only}
  • Georgoulis B, Papaioannou N, Anagnostopoulou P. Open randomized study of cefoxitin versus metronidazole in the prevention of infection after colorectal surgery. American Journal of Proctology, Gastroenterology and Colon and Rectal Surgery 1983;34(7):10-1+19.
Germiniani 1998 {published data only}
  • Germiniani R, Montorsi W. Pefloxacin + metronidazole versus netilmicin + metronidazole in the prevention of nosocomial infections in contaminated surgery. Pefloxacin Study Group. Minerva Chirurgica 1998;53(1-2):103-12.
Gerner 1989 {published data only}
  • Gerner T, Nygaard K, Kaaresen R, Mjoerud J, Larsen S. Antibiotic prophylaxis in colorectal surgery. Acta Chirurgica Scandinavica 1989;155:121-4.
Giercksky 1982 {published data only}
  • Giercksky KE, Danielsen S, Garberg O. A single dose tinidazole and doxycycline prophylaxis in elective surgery of colon and rectum. A prospective controlled clinical multicenter study. Annals of Surgery 1982;195(2):227-31.
Giercksky 1985 {published data only}
  • Giercksky K-E. Should antimicrobial prophylaxis in colorectal surgery include agents effective against both anaerobic and aerobic microorganisms? A double-blind, multicenter study. Surgery 1985;97(4):402-8.
Gillespie 1978 {published data only}
Goldring 1975 {published data only}
Goransson 1984 {published data only}
  • Goransson G, Nilsson-Ehle I, Olsson S-A, Petersson BG, Bengmark S. Single versus multiple dose doxycycline prophylaxis in elective colorectal surgery. Acta Chirurgica Scandinavica 1984;150:245-9.
Gortz 1990 {published data only}
  • Gortz G, Boese-Landgraf J, Hopfenmuller W, Rodloff A, Kotwas J. Ciprofloxacin as single-dose antibiotic prophylaxis in colorectal surgery. Diagnostic Microbiology and Infectious Disease 1990;13:181-5.
Gottrup 1985 {published data only}
  • Gottrup F, Diederich P, Sorensen K, Nielsen SV, Ornsholt J, Brandsborg O. Prophylaxis with whole gut irrigation and antimicrobials in colorectal surgery: a prospective, randomised double-blind clinical trial. American Journal of Surgery 1985;149:317-22.
Grundmann 1987 {published data only}
  • Grundmann R, Burkardt F, Scholl H, Koelschbach D. One versus three doses of metronidazole/mezlocillin for antibiotic prophylaxis in colon surgery. Chemioterapia 1987;6(2):604-5.
Gruner 1980 {published data only}
  • Gruner OP, Holter O, Baardsen A. Combined tinidazole and doxycycline prophylaxis in colorectal surgery. An interhospital trial. Scandinavian Journal of Gastroenterology. Supplement 1980;59:25-8.
Gruttadauria 1987 {published data only}
  • Gruttadauria G, La Barbera F, Cutaia G, Salanitri G. Prevention of infection in colonic surgery by rifaximin. A controlled, prospective, randomized trial. Rivista Europea per le Scienze Mediche e Farmacologiche [European Review for Medical and Pharmacological Sciences] 1987;9(1):101-5.
Hagen 1980 {published data only}
  • Hagen TB, Bergan T, Liavag I. Prophylactic metronidazole in electrive colo-rectal surgery. Acta Chirurgica Scandinavica 1980;146(1):71-5.
Hakansson 1993 {published data only}
  • Hakansson T, Raahave D, Hansen OH, Pedersen T. Effectiveness of single dose prophylaxis with cefotaxime and metronidazole compared with three doses of cefotaxime alone in elective colorectal surgery. European Journal of Surgery 1993;159:177-80.
Hall 1989a {published data only}
  • Hall JC, Watts JM, O'Brien P, Turnbridge J, McDonald P. Single-dose antibiotic prophylaxis in contaminated abdominal surgery. Archives of Surgery 1989;124:224-7.
Hall 1989b {published data only}
  • Hall C, Curran F, Burdon DW, Keighley MRB. A randomized trial to compare amoxycillin/clavulanate with metronidazole plus gentamicin in prophylaxis in elective colorectal surgery. Journal of Antimicrobial Chemotherapy 1989;24(Suppl B):195-202.
Hall 1991 {published data only}
Hancke 1986 {published data only}
  • Hancke E, Marklein G, Jensen JC, Voigt U, Stute H, Berker-von-Schlichting C. Antimicrobial chemoprevention in colorectal interventions: a single parenteral dose at the start of surgery is adequate. Chirurgie 1986;57(6):406-10.
  • Hancke E, Marklein G, Jensen JC, Voigt U, Stute H, Berker-von-Schlichting C. Antimicrobial chemoprevention in colorectal interventions: a single parenteral dose at the start of surgery is adequate [Antimikrobielle Chemoprophylaxw bein colorectalen Eingriffen Parenterale Einmalgabe bei]. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen 1986;57:406-10.
Hansell 1983 {published data only}
  • Hansell DT, Thomson GJ, Simpson CJ, Morran C, Smith DC, McNaught W, et al. Metronidazole prophylaxis in colorectal surgery: the need for additional aminoglycoside?. Journal of Hospital Infection 1983;4(4):383-90.
Haverkorn 1985 {published data only}
Hershman 1987 {published data only}
  • Hershman M, Reilly D, Sackier J, Gompertz H, Swift R, Wood C. A prospective comparative study of cefotetan with piperacillin for prophylaxis against infection in elective colorectal surgery. Chemioterapia 1987;6(2 Suppl):600.
Hershman 1990 {published data only}
  • Hershman MJ, Swift RI, Reilly DT, Logan WA, Sackier JM, Gompertz H, et al. Prospective comparative study of cefotetan with piperacillin for prophylaxis against infection in elective colorectal surgery. Journal of the Royal College of Surgeons of Edinburgh 1990;35(1):29-32.
Hinchey 1983 {published data only}
Hinchey 1987 {published data only}
  • Hinchey EJ, Richards GK, Lewis R, Echave V, Biron JS, Weissglass I. Moxalactam as single-agent prophylaxis in the prevention of wound infection following colon surgery. Surgery 1987;101(1):15-9.
Hobbiss 1988 {published data only}
  • Hobbiss JH, Carr ND, Schofield PF. Are we using the correct dose of metronidazole in colorectal surgery?. Journal of the Royal Society of Medicine 1988;81(2):95-6.
Hoffmann 1981 {published data only}
  • Hoffman CEJ, McDonald PJ, Watts J. Use of peroperative cefoxitin to prevent infection after colonic and rectal surgery. Annals of Surgery 1981;193(3):353-6.
Höjer 1978 {published data only}
  • Höjer H. The effect on total antimicrobial consumption and hospitalization time after prophylactic treatment with doxycycline in colorectal surgery. Acta Chirurgica Scandinavica 1978;144(3):175-9.
Höjer 1980 {published data only}
  • Hoejer H, Wetterfors J. On the effect on antimicrobial use and postoperative hospital stay of prophylactic treatment with doxycycline in colorectal surgery. Scandinavian Journal of Gastroenterology 1980;Suppl 59:5-9.
Hosie 1992 {published data only}
  • Hosie KB, Fielding JWL, Alexander-Williams J, Temple JG, Keighley MRB. Ceftizoxime alone or in combination with metronidazole as prophylaxis in elective colorectal surgery. Drug Investigation 1992;4(1):13-6.
Hughes 1979 {published data only}
Hunt 1979 {published data only}
  • Hunt PS, Francis JK, Peck G, Farrell K, Sali A. Tinidazole in the prevention of wound infection after elective colorectal surgery. Medical Journal of Australia 1979;1(4):107-9.
Ishida 2001 {published data only}
  • Ishida H, Yokoyama M, Nakada H, Inokuma S, Hashimoto D. Impact of oral antimicrobial prophylaxis on surgical site infection and methicillin-resistant Staphylococcus aureus infection after elective colorectal surgery. Results of a prospective randomized trial. Surgery Today 2001;31(11):979-83.
Itani 2006 {published data only}
Ivarsson 1982 {published data only}
  • Ivarsson L, Darle N, Kewenter JG, Seeberg S, Norrby R. Short-term systemic prophylaxis with cefoxitin and doxycycline in colorectal surgery. A prospective, randomized study. American Journal of Surgery 1982;144(2):257-61.
Jagelman 1982 {published data only}
  • Jagelman DG, Fazio VW, Lavery IC, Weakley FL, Chaney TL. A prospective randomized study of prophylactic mannitol (10%)-neomycin-cefotaxime therapy in patients undergoing elective colonic and rectal surgery. Clinical Therapeutics: 1982;5 Suppl A:32-7.
Jagelman 1985 {published data only}
  • Jagelman DG, Fazio VW, Lavery IC, Weakley FL. A prospective, randomised, double-blind study of 10% mannitol mechanical bowel preparation combined with oral neomycin and short-term, perioperative, intravenous Flagyl as prophylaxis in elective colorectal resections. Surgery 1985;98(5):861-5.
Jagelman 1987 {published data only}
  • Jagelman DG, Fazio VW, Lavery IC, Weakley FL, Tusek D. Single-dose piperacillin versus cefoxitin combined with 10 percent mannitol bowel preparation as prophylaxis in elective colorectal operations. American Journal of Surgery 1987;154(5):478-81.
Jagelman 1988 {published data only}
  • Jagelman DJ, Fabian TC, Nichols RL, Stone HH, Wilson SE, Zellner SR. Single-dose cefotetan versus multiple-dose cefoxitin as prophylaxis in colorectal surgery. American Journal of Surgery 1988;155(5A):71-6.
Jensen 1990 {published data only}
  • Jensen LS, Anderson A, Fristrup SC, Holme JB, Hvid HM, Kraglund K, et al. Comparison of one dose versus three doses of prophylactic antibiotics and the influence of blood transfusion, on infectious complications in acute and elective colorectal surgery. British Journal of Surgery 1990;77(5):513-8.
Jones 1987 {published data only}
  • Jones RN, Wojeski W, Bakke J, Porter C, Searles M. Antibiotic prophylaxis of 1,036 patients undergoing elective surgical procedures: a prospective randomized comparative trial of cefazolin, cefoxitin and cefotaxime in a prepaid medical practice. American Journal of Surgery 1987;153:341-6.
Jones 1987b {published data only}
  • Jones RN, Wojeski WV. Single-dose surgical prophylaxis using ticarcillin/clavulanic acid (Timentin): a prospective, randomized comparison with cefotaxime. Diagnostic Microbiology and Infectious Disease 1987;7:219-23.
Jones 1987c {published data only}
  • Jones RN, Slepack JM, Wojeski WV. Cefotaxime single-dose surgical prophylaxis in a pre-paid group practice. Comparisons with other cephalosporins and ticarcillin/clavulanic acid. Drugs 1988;35(Suppl 2):116-23.
  • Jones RN, Wojeski WV. Single-dose cephalosporin prophylaxis of 929 surgical procedures in a prepaid group practice: A prospective, randomised comparison of cefoperazone and cefotaxime. Diagnostic Microbiology and Infectious Disease 1987;6:323-34.
Jostarndt 1980 {published data only}
  • Jostarndt L, Thiede A, Sonntag HG, Hamelmann H. Controlled, randomized prospective study on the merit of systemic antibiotic prophylaxis with cefotaxime in elective colon surgery [Kontrollierte, prospektive, randomisierte Studie zum Wert der systemischen Antibioticumprophylaxe mit Cefotaxime in der elektiven Dickdarmchirurgie]. Langenbecks Archiv fur Chirurgie 1980;352(1):568.
Juul 1987 {published data only}
Kaiser 1983 {published data only}
  • Kaiser AB, Herrington JL Jr, Jacobs JK, Mulherin JL Jr, Roach AC, Sawyers JL. Cefoxitin versus erythromycin, neomycin, and cefazolin in colorectal operations. Importance of the duration of the surgical procedure. Annals of Surgery 1983;198(4):525-30.
Karran 1993 {published data only}
Keighley 1976 {published data only}
Keighley 1979 {published data only}
Keighley 1983 {published data only}
Khubchandani 1989 {published data only}
  • Khubchandani IT, Karamchandani MC, Sheets JA, Stasik JJ, Rosen L, Riether RD. Metronidazole vs. erythromycin, neomycin and cefazolin in prophylaxis for colonic surgery. Diseases of the Colon and Rectum 1989;32(1):17-20.
Kingston 1989 {published data only}
  • Kingston RD, Kiff RS, Duthie JS, Walsh S, Spicer A, Jeacock J. Comparison of two prophylactic single-dose intravenous antibiotic regimes in the treatment of patients undergoing elective colorectal surgery in a district general hospital. Journal of the Royal College of Surgeons of Edinburgh 1989;34:208-11.
Kläy 1983 {published data only}
  • Kläy K, Hassler H, Aeberhard P. Perioperative antibiotic prophylaxis in colon surgery. Metronidazole and tobramycin versus metronidazole alone. A prospective randomized study. Schweizerische Medizinische Wochenschrift 1983;113(11):392-4.
Kling 1985 {published data only}
  • Kling PA, Homlund D, Burman L. Single-dose intravenous metronidazole v. doxycycline prophylaxis in colorectal surgery. An open prospective, randomized trial. Acta Chirurgica Scandinavica 1985;151:163-8.
Kling 1988 {published data only}
  • Kling PA, Burman LG. Failure of single-dose metronidazole prophylaxis in colorectal surgery. No benefit from high dosage or combination with nalidixic acid. Acta Chirurgica Scandinavica 1988;154:305-9.
Kling 1989 {published data only}
Kobayashi 2007 {published data only}
  • Kobayashi M, Mohri Y, Tonouchi H, Miki C, Nakai K, Kusunoki M, et al. Randomized clinical trial comparing intravenous antimicrobial prophylaxis alone with oral and intravenous antimicrobial prophylaxis for the prevention of a surgical site infection in colorectal cancer surgery. Surgery Today 2007;37(5):383-8.
Kow 1995 {published data only}
  • Kow L, Toouli J, Brookman J, McDonald PJ. Comparison of cefotaxime plus metronidazole versus cefoxitin for prevention of wound infection after abdominal surgery. World Journal of Surgery 1995;19:680-6.
Kow 1995a {published data only}
  • Kow L, Toouli J, Brookman J, McDonald PJ. Comparison of cefotaxime plus metronidazole versus cefoxitin for prevention of wound infection after abdominal surgery. World Journal of Surgery 1995;19:680-6.
Kwok 1993 {published data only}
  • Kwok SP, Lau WY, Leung KL, Ku KW, Ho WS, Li AK. Amoxycillin and clavulanic acid versus cefotaxime and metronidazole as antibiotic prophylaxis in elective colorectal resectional surgery. Chemotherapy 1993;39:135-9.
Lafaix 1983 {published data only}
  • Lafaix C, Langlois O. Comparative study of tinidazole and ornidazole for the prevention of septic complications of colonic surgery [French] [Etude comparative tinidazole-ornidazole pour la prophylaxie des complications septiques de la chirurgie colique]. Pathologie Biologie 1983;31(6):509-11.
Laitinen 1984a {published data only}
  • Laitinen S, Stahlberg M, Kairaluoma MI. Tinidazole prophylaxis in elective colorectal surgery. Scandinavian Journal of Gastroenterology 1984;19(8):1027-30.
Lau 1988 {published data only}
Lauridsen 1988 {published data only}
  • Lauridsen F, Bjoernsen K, Nielsen SAD, Hansen OH. Short-term prophylaxis with cefotaxime in colorectal surgery: a prospective, randomized trial. Diseases of the Colon and Rectum 1988;31(1):25-7.
Lazorthes 1982 {published data only}
  • Lazorthes F, Legrand G, Monrozies X, Fretigny E, Pugnet G, Cordova JA, et al. Comparison between oral and systemic antibiotics and their combined use for the prevention of complications in colorectal surgery. Diseases of the Colon and Rectum 1982;25(4):309-11.
Leandoer 1976 {published data only}
  • Leandoer L, Ekelund G, Genell S, Olson S. Antibiotic prophylaxis in colorectal surgery. Deoxycycline compared to a combination of benzylpenicillin and streptomycin. A preliminary report. Scandinavian Journal of Infectious Diseases. Supplementum 1976;9:106-8.
Lewis 1978 {published data only}
  • Lewis RT, Allan CM, Goodall RG, Lloyd-Smith WC, Marien B, Wiegand F. Antibiotics in surgery of the colon. Canadian Journal of Surgery. Journal Canadien de Chirurgie 1978;21(4):339-41.
Lewis 1981 {published data only}
  • Lewis RT, Allan CM, Goodall RG, Lloyd-Smith WC, Marien B, Park M, et al. Preventing anaerobic infection in surgery of the colon. Canadian Journal of Surgery. Journal Canadien de Chirurgie 1981;24(2):139-41.
Lewis 1983 {published data only}
  • Lewis RT, Allan CM, Goodall RG, Marien B, Park M, Lloyd-Smith W, et al. Are first-generation cephalosporins effective for antibiotic prophylaxis in elective surgery of the colon?. Canadian Journal of Surgery. Journal Canadien de Chirurgie 1983;26(6):504-7.
Lewis 1989 {published data only}
  • Lewis RT, Goodall RG, Marien B, Lloyd-Smith W, Park M, Wiegand FM. Is neomycin necessary for bowel preparation in surgery of the colon? Oral neomycin plus erythromycin versus erythromycin-metronidazole. Canadian Journal of Surgery. Journal Canadien de Chirurgie 1989;32(4):265-70.
Lewis 2002 {published data only}
  • Lewis RT. Oral versus systemic antibiotic prophylaxis in elective colon surgery: a randomized study and meta-analysis send a message from the 1990s. Canadian Journal of Surgery. Journal Canadien de Chirurgie 2002;45(3):173-80.
Lindhagen 1984 {published data only}
  • Lindhagen J, Andaker L, Hojer H. Comparison of systematic prophylaxis with metronidazole/placebo and metronidazole/fosfomycin in colorectal surgery. Acta Chirurgica Scandinavica 1984;150:317-23.
Lohde 1992 {published data only}
  • Lohde E, Scholz L, Gemperle A, Langmark H, Hopfenmuller W, Abri O, et al. Comparative analysis of mezocillin/metronidazole and amoxicillin/clavulanic acid as 'one-shot' antibiotic prophylaxis in colorectal surgery [German]. Zentralblatt für Chirurgie 1992;117:325-30.
Lohr 1984 {published data only}
  • Lohr J, Wagner PK, Rothmund M. Peri-operative antibiotic prophylaxis (single of multiple dose) in elective colorectal surgery [Perioperative antibioticaprophylaxe (Einmal-oder Mehrfachgabe) bei elektiven colorectalen eingriffen]. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen 1984;55:512-4.
Lozano 1985 {published data only}
  • Lozano F, Alonso AG, Almazan A, Garcia JG, Cuadrado F, Moran MR. A comparison of three different prophylactic parenteral antibiotic regimens of colorectal surgery: A prospective study. International Surgery 1985;70(3):227-31.
Luke 1991 {published data only}
  • Luke M, Iversen J, Sondergaard J, Kvist E, Lund P, Andersen F, et al. Ceftriaxone versus ampicillin and metronidazole as prophylaxis against infections after clean-contaminated abdominal surgery. European Journal of Surgery 1991;157:45-9.
Lumley 1992 {published data only}
Lykkegaard 1978 {published data only}
  • Lykkegaard Nielsen M, Scheibel JH, Wamberg T. Septic complications in colo-rectal surgery after 24 hours versus 60 hours of preoperative antibiotic bowel preparation. I. Prospective, randomized, double-blind clinical study. Acta Chirurgica Scandinavica 1978;144(7-8):523-6.
Maki 1982 {published data only}
  • Maki DG, Aughey DR. Comparative study of cefazolin, cefoxitin, and ceftizoxime for surgical prophylaxis in colorectal surgery. Journal of Antimicrobial Chemotherapy 1982;10(Suppl C):281-7.
Marti 1982 {published data only}
  • Marti MC, Auckenthaler R. Antibiotic prophylaxis in colorectal surgery: results of a randomized clinical study. Helvetica Chirurgica Acta 1982;49(3-4):527-36.
Matheson 1978 {published data only}
Matikainen 1993 {published data only}
  • Matikainen M, Hiltunen KM. Parenteral single dose ceftriaxone with tinidatsole versus aminoglycoside with tinidatsole in colorectal surgery: a prospective single-blind randomized multicentre study. International Journal of Colorectal Disease 1993;8:148-50.
McArdle 1995 {published data only}
McArdle 1995 A {published data only}
McCulloch 1986 {published data only}
  • McCulloch PG, Blamey SL, Finlay IG, Baird A, Sleigh D, Gardner E, et al. A prospective comparison of gentamicin and metronodazole and moxalactam in the prevention of septic complications associated with elective operations of the colon and rectum. Surgery, Gynecology and Obstetrics 1986;162(6):521-4.
McDermott 1981 {published data only}
  • McDermott FT, Polglase AL, Johnson WR, Hughes ES. Prevention of wound infection in elective colorectal resections by preoperative cephazolin with and without metronidazole. Australian & New Zealand Journal of Surgery 1981;51(4):351-3.
McDonald 1983 {published data only}
  • McDonald PJ, Karran SJ. A comparison of intravenous cefoxitin and a combination of gentamicin and metronidazole as prophylaxis in colorectal surgery. Diseases of the Colon and Rectum 1983;26(10):661-4.
McEntee 1989 {published data only}
  • McEntee G, Mulvin D, Tournay A, Rosenberg IL, Devlin HB, Peel ALG. Single-dose antibiotic prophylaxis in elective colorectal surgery. Results of a randomized controlled clinical trial. Digestive Surgery 1989;6(4):199-203.
McLeish 1987 {published data only}
  • McLeish AR, Waxman B, Ross H, Allsop JR, Andrew JH, Bennett RC, et al. Systemic Timentin is superior to oral tinidazole for antibiotic prophylaxis in elective colorectal surgery. Diseases of the Colon and Rectum 1987;30(10):786-9.
Mehigan 1981 {published data only}
  • Mehigan D, Zuidema GD, Cameron JL. The role of systemic antibiotics in operations upon the colon. Surgery, Gynecology and Obstetrics 1981;153(4):573-6.
Mendel 1985 {published data only}
  • Mendel V. One-shot prophylaxis with latamoxef in elective colorectal surgery [Einmalprophylaxe mit latamoxef in der elektiven kolonchirurgie]. Medizinische Klinik 1985;80(18):495-7.
Mendel 1987 {published data only}
  • Mendel V, Jung D, Heymann H. Single-shot antibiotic prophylaxis in colon surgery. Chemioterapia 1987;6:597-600.
Mendes 1977 {published data only}
  • Mendes da Costa P, Klastersky J, Gerard A. Controlled study of oral administration of antibiotics in the preparation of digestive surgery (author's transl) [French] [Etude controlee de l'administration orale d'antibiotiques comme preparation a la chirurgie digestive]. Acta Chirurgica Belgica 1977;76(5):475-80.
Menzel 1993 {published data only}
  • Menzel J, Bauer J, Pritzbuer E, Klempa I. Perioperative use of ampicillin/sulbactam, cefoxitin and piperacillin/metronidazole in elective colon and rectal surgery. A prospective randomized quality assurance study of 422 patients [Perioperative anwendung von ampicillin/sulbacatm, cefoxitin und piperacillin/metronidazol in der elektiven colon-und rectumchirurgie [German]]. Der Chirurg 1993;64:649-52.
Menzel 1993 A {published data only}
  • Menzel J, Bauer J, Pritzbuer E, Klempa I. Perioperative use of ampicillin/sulbactam, cefoxitin and piperacillin/metronidazole in elective colon and rectal surgery. A prospective randomized quality assurance study of 422 patients [Perioperative anwendung von ampicillin/sulbacatm, cefoxitin und piperacillin/metronidazol in der elektiven colon-und rectumchirurgie [German]]. Der Chirurg 1993;64:649-52.
Menzies 1989 {published data only}
  • Menzies D, Gilbert JM, Shepherd MJ, Rogers TR. A comparison between amoxycillin/clavulanate and mezlocillin in abdominal surgical prophylaxis. Journal of Antimicrobial Chemotherapy 1989;24(Suppl B):203-8.
Milsom 1998 {published data only}
  • Milsom JW, Smith DL, Corman ML, Howerton RA, Yellin AE, Luke DR (Trovafloxacin Surgical Group). Double-blind comparison of single-dose alatrofloxacin and cefotetan as prophylaxis of infection following elective colorectal surgery. American Journal of Surgery 1998;176(6A Suppl):46S-52S.
Mitchell 1983 {published data only}
Mittermayer 1984 {published data only}
  • Mittermayer H, Gross C, Brucke P. Single dose cefuroxime/metronidazole versus metronidazole alone in elective colorectal surgery. The American Surgeon 1984;50(8):418-23.
Moen 1980 {published data only}
  • Moen OO, Tveter KJ. The value of the prophylactic use of doxycycline and tinidazole in elective colorectal surgery. Scandinavian Journal of Gastroenterology. Supplement 1980;59:17-20.
Moesgaard 1988 {published data only}
  • Moesgaard F, Nielsen ML. Failure of topically applied antibiotics, added to systematic prophylaxis, to reduce perineal wound infection in abdominoperineal excision of the rectum. Acta Chirurgica Scandinavica 1988;154:589-92.
Moesgaard 1989 {published data only}
  • Moesgaard F, Lykkegaard-Nielsen M. Preoperative cell-meditated immunity and duration of antibiotic prophylaxis in relation to postoperative infectious complications. Acta Chirurgica Scandinavica 1989;155:281-6.
Monrozies 1983 {published data only}
  • Monrozies X, Lazorthes F, Fretigny E, Chiotasso P, Massip P. Evaluation of systemic antibiotic preventive treatment in colorectal surgery [Appreciation de l'antibio-prophylaxie systemique en chirurgie colo-rectale]. Journal de Chirurgie 1983;120(6-7):393-6.
Montariol 1979 {published data only}
  • Montariol T, Hay JM, Lauru Y, Dazza F, Maillard JN. Effect of pre-operative oral antibiotics on septic complications following resection for cancer and diverticular disease of the colon. Controlled clinical trial (author's transl) [French] [Les effets de l'antibiotherapie orale pre-operatoire sur les complications septiques des resections pour cancer du colon ou sigmoidite. Une etude controlee]. Annales de Chirurgie 1979;33(6):413-6.
Morris 1983 {published data only}
  • Morris DL, Hares MM, Voogt RJ, Burdon DW, Keighley MR. Metronidazole need not be combined with an aminoglycoside when used for prophylaxis in elective colorectal surgery. Journal of Hospital Infection 1983;4(1):65-9.
Morris 1984 {published data only}
  • Morris DL, Fabricius PJ, Ambrose NS, Scammell B, Burdon DW, Keighley MRB. A high incidence of bleeding is observed in a trial to determine whether addition of metronidazole is needed with latamoxef for prophylaxis in colorectal surgery. Journal of Hospital Infection 1984;5:398-408.
Morris 1990 {published data only}
  • Morris DL, Wilson SR, Pain J, Edwardson KF, Jones J, Strachan C, et al. A comparison of aztreonam/metronidazole and cefotaxime/metronidazole in elective colorectal surgery: antimicrobial prophylaxis must include Gram-positive cover. Journal of Antimicrobial Chemotherapy 1990;25:673-8.
Morris 1993 {published data only}
  • Morris WT. Ceftriaxone is more effective than gentamicin/metronidazole prophylaxis in reducing wound and urinary tract infections after bowel operations: Results of a controlled, randomized, blind clinical trial. Diseases of the Colon and Rectum 1993;36(9):826-33.
Morton 1989 {published data only}
  • Morton AL, Taylor EW, Lindsay G, Wells GR. A multicenter study to compare cefotetan alone with cefotetan and metronidazole as prophylaxis against infection in elective colorectal operations. Surgery, Gynecology and Obstetrics 1989;169:41-5.
Mosimann 1987 {published data only}
  • Mosimann F, Chamero J. Preventive preoperative antibiotic therapy in elective colon surgery. A controlled prospective randomized study. Schweizerische Medzinische Wochenschrift 1987;117(15):570-3.
Mosimann 1997 {published data only}
Mozzillo 1989 {published data only}
Navarro 1988 {published data only}
  • Navarro A, Suárez MA, López B, Lage JM, Fernández de Rota A, Maté A, et al. Anti-infection prophylaxis in colorectal surgery. A comparative study between two antibiotic regimens [Profilaxis antiinfecciosa en cirugía colorrectal. Estudio comparativo entre dos regímenes antibióticos]. Cirugía Española 1988;43(1):87-91.
Nel 1989 {published data only}
  • Nel CJC. Ceftriaxone as prophylaxis for elective abdominal and colorectal surgery. South African Journal of Surgery 1989;Suppl:6.
Nichols 1973 {published data only}
  • Nichols RL, Broido P, Condon RE, Gorbach SL, Nyhus LM. Effect of preoperative neomycin-erythromycin intestinal preparation on the incidence of infectious complications following colon surgery. Annals of Surgery 1973;178:453-9.
Nohr 1990 {published data only}
  • Nohr M, Andersen JC, Juul-Jensen KE. Prophylactic single-dose fosfomycin and metronidazole compared with neomycin, bacitracin, metronidazole and ampicillin in elective colorectal operations. Acta Chirurgica Scandinavica 1990;156:223-30.
Norwegian Study 1985 {published data only}
  • The Norwegian Study Group for Colorectal Surgery. Should antimicrobial prophylaxis in colorectal surgery include agents effective against both anaerobic and aerobic microorganisms? A double-blind, multicenter study. Surgery 1985;97(4):402-7.
Nyam 1995 {published data only}
  • Nyam DCNK, Yeo M, Cheong D, Goth HS. Antibiotic prophylaxis in colorectal surgery: a randomised, double-blind, controlled trial of amoxycillin-clavulanic acid versus ceftriaxone and metronidazole. Asian Journal of Surgery 1995;18(3):227-30.
Nygaard 1980 {published data only}
  • Nygaard K, Hognestad J. Infection prophylaxis with doxycycline in colorectal surgery. A preliminary report. Scandinavian Journal of Gastroenterology. Supplement 1980;59:37-9.
Offer 1988 {published data only}
Ofstad 1980 {published data only}
  • Ofstad E, Brabrand G, Helsingen N, Uggerud R, Jorgensen J, Lien E, et al. Tinidazole and doxycycline as antimicrobials in elective colorectal surgery. A randomized multicentre trial. Scandinavian Journal of Gastroenterology. Supplement 1980;59:29-35.
Olsen 1983 {published data only}
  • Olsen PR, Andersen HH, Hebjorn M, Pedersen VM, Hansen LK. The prophylaxis of metronidazole in colorectal surgery. Danish Medical Bulletin 1983;30(5):345-8.
Pacelli 1991 {published data only}
  • Pacelli F, Brisinda G, Bellantone R, Doglietto GB, Crucitti F. Single dose imipenem-cilastatin compared with three doses of cefuroxime and metronidazole as prophylaxis in elective colorectal surgery: a prospective randomized study. Journal of Chemotherapy 1991;3(6):372-5.
Palla 1989 {published data only}
  • Palla Garcia J, Consiglieri Pedroso J. Ceftriaxone single dose versus ceftazidime multiple doses in the prophylaxis of infection in colorectal surgery. European Surgical Research 1989;21(Suppl 1):14-8.
Panichi 1982 {published data only}
  • Panichi G, Pantosti A, Giunchi G, Tonelli F, D'Amicis P, Fegiz G, et al. Cephalothin, cefoxitin, or metronidazole in elective colonic surgery? A single-blind randomized trial. Diseases of the Colon and Rectum 1982;25(8):783-6.
Park 2010 {published data only}
  • Park JW, Oh JH, Choi HS, Yoo S-B, Choe Y-J, Park S, et al. A prospective, multicenter, randomized trial for duration of the prophylactic antibiotics after elective colorectal surgery: 3 days versus 5 days. Journal of the Korean Society of Coloproctology 2010;26(2):123-8.
Peiper 1996 {published data only}
  • Peiper C, Seelig M, Schumpelick V. Low dose perioperative antibiotic prophylaxis in colorectal surgery. A prospective randomized study in 60 patients [Stellenwert der niedrig dosierten perioperativen antibiotikaprophylaxe bei kolorektalen eingriffen. Eine prospektive randomisierte studie an 60 patienten]. Aktuelle Chirurgie 1996;31(3):164-7.
Peiper 1997 {published data only}
Periti 1989 {published data only}
  • Periti P, Mazzei T, Tonelli F. Single-dose cefotetan vs. multiple-dose cefoxitin-antimicrobial prophylaxis in colorectal surgery. Results of a prospective, multicenter, randomised study. Diseases of the Colon and Rectum 1989;32(2):121-7.
Periti 1993 {published data only}
  • Periti P, Tonelli F, Mazzei T, Ficari F. Antimicrobial chemoimmunoprophylaxis in colorectal surgery with cefotetan and thymostimulin: prospective controlled multicenter study. Italian Study Group on Antimicrobial Prophylaxis in Abdominal Surgery. Journal of Chemotherapy 1993;5(1):37-42.
Perrott 1985 {published data only}
  • Perrott CAV, Hinder RA, Cassel R, Koornhof HJ, Naude G, Kleinman M, et al. Prophylactic antimicrobials in elective colorectal and biliary surgery. South African Medical Journal 1985;68:387-91.
Peruzzo 1987 {published data only}
  • Peruzzo L, Savio S, Lalla FD. Systematic versus systematic plus oral chemoprophylaxis in elective colorectal surgery. Chemioterapia 1987;6:601-2.
Petermann 1983 {published data only}
  • Petermann C, Wesch G, Saeger HD, Linder MM. The significance of anaerobes for perioperative antibiotic prophylaxis in elective colorectal surgery [Die Bedeutung der Anaerobier fur die perioperative Antibioticaprophylaxe bei elektiver colorectaler Chirurgie]. Langenbecks Archiv fur Chirurgie 1983;359(Suppl):63-7.
Petrelli 1988 {published data only}
  • Petrelli NJ, Conte CC, Herrera L, Stulc J, O'Neill P. A prospective trial of preoperative prophylactic cefamandole in elective colorectal surgery for malignancy. Diseases of the Colon and Rectum 1988;31(6):427-9.
Petropoulos 1985 {published data only}
  • Petropoulos P, Dietrich PY, Ammann J, Ayer G, Buchmann P, Martinoli S. Single-dose antibiotic prophylaxis for elective colorectal surgery. Multicenter study in Switzerland [Prophylaxie antibiotique par dose unique pour la chirurgie colo-rectale elective]. Helvetica Chirurgica Acta 1985;52:703-6.
Playforth 1987 {published data only}
  • Playforth MJ, Smith GMR, Evans M, Pollock AV. Single-dose intravenous antibiotics for the prophylaxis of abdominal surgical wound infection: a trial of amoxycillin/clavulanate against latamoxef. Surgical Research Communications 1987;1:173-80.
Playforth 1988 {published data only}
Plouffe 1985 {published data only}
  • Plouffe JF, Perkins RL, Fass RJ, Carey LC, Macynski ME. Comparison of the effectiveness of moxalactam and cefazolin in the prevention of infection in patients undergoing abdominal operations. Diagnostic Microbiology and Infectious Disease 1985;3:25-31.
Plouffe 1989 {published data only}
  • Plouffe JF. Cefmetazole versus cefoxitin in prevention of infections after abdominal surgery. Journal of Antimicrobial Chemotherapy 1989;23(Suppl D):85-8.
Pollock 1989 {published data only}
  • Pollock AV, Evans M, Smith GMR. Preincisional intraparietal Augmentin in abdominal operations. Annals of the Royal College of Surgeons of England 1989;71:97-100.
Proud 1979 {published data only}
  • Proud G, Chamberlain J. Antimicrobial prophylaxis in elective colonic surgery. Lancet 1979; Vol. 2, issue 8150:1017-8.
Raetzel 1986 {published data only}
  • Raetzel G, Harnoss BM, Görtz G, Häring R, Rodloff A. Systemic antibiotic prophylaxis with metronidazole in elective colonic and rectal surgery. Results of a clinical controlled study and a critical literature review [Systemische Antibiotikaprophylaxe mit Metronidazol in der elektiven Kolon- und Rektumchirurgie. Ergebnisse einer klinisch-kontrollierten Studie und kritische Literaturübersicht]. Arzneimittel-Forschung 1986;36(6):976-80.
Rangabashyam 1991 {published data only}
Reers 1989 {published data only}
  • Reers B, Winde G, Sulkowski U, Blum M. Single-dose prophylaxis in elective colorectal surgery: a prospective, randomized trial with piperacillin or latamoxef. Journal of Chemotherapy 1989;1(4 Suppl):997-8.
Renner 1989 {published data only}
  • Renner H, Losch H. Experiences with ceftriaxone (Rocephin) in perioperative antibiotic prophylaxis for elective colon surgery. Journal of Chemotherapy (Florence, Italy) 1989;1(4 Suppl):1005-6.
Reynolds 1989 {published data only}
  • Reynolds JR, Jones JA, Evans DF, Hardcastle JD. Do preoperative oral antibiotics influence sepsis rates following elective colorectal surgery in patients receiving perioperative intravenous prophylaxis. Surgical Research Communications 1989;7:71-7.
Rodolico 1991 {published data only}
  • Rodolico G, Puelo S, Blandono G, Russello D, Amoedo C, Latteri F, et al. Colorectal surgery: short-term prophylaxis with clindamycin plus aztreonam or gentamicin. Reviews of Infectious Diseases 1991;13(7):612-5.
Roland 1985 {published data only}
  • Roland M, Bergan T, Bjerkeset T, Erichsen H, Hoel R, Johansen S, et al. Prophylactic regimens in colorectal surgery: comparisons between metronidazole used alone or with ampicillin for one or three days. World Journal of Surgery 1985;9(4):626-32.
Roland 1985a {published data only}
  • Roland M, Bergan T, Bjerkeset T, Erichsen H, Hoel R, Johansen S, et al. Prophylactic regimens in colorectal surgery: comparisons between metronidazole used alone or with ampicillin for one or three days. World Journal of Surgery 1985;9(4):626-32.
Roland 1986 {published data only}
  • Roland M. Prophylactic regimens in colorectal surgery: An open, randomised, consecutive trial on metronidazole used alone or in combination with ampicillin or doxycycline. World Journal of Surgery 1986;10:1003-8.
Rorbaek-Madsen 1988 {published data only}
  • Rorbaek-Madsen M, Toftgaard C, Graversen HP, Kristiansen JD, Lauesen N, Randberg FA, et al. Cefoxitin for one day versus ampicillin and metronidazole for three days in elective colorectal surgery. Diseases of the Colon and Rectum 1988;31(10):774-7.
Rosenberg 1971 {published data only}
Rowe-Jones 1990 {published data only}
  • Rowe-Jones DC, Peel ALG, Kingston RD, Shaw JFL, Teasdale C, Cole DS. Single dose cefotaxime plus metronidazole versus three dose cefuroxime plus metronidazole as prophylaxis against wound infection in colorectal surgery: multicentre prospective randomised study. BMJ 1990;300:18-22.
Ryan 1986 {published data only}
  • Ryan PJ, Fink RLW, Ross Hetal. Clinical trial of prophylaxis of wound sepsis in elective colorectal surgery comparing ticarcillin with tinidazole. Australian and New Zealand Journal of Surgery 1986;56(3):209-13.
Sato 2009 {published data only}
  • Sato T, Takayama T, Fujii M, Song K, Matsuda M, Higaki T, et al. Systemic use of antibiotics does not prevent postoperative infection in elective colorectal surgery: a randomized controlled trial. Journal of Infection & Chemotherapy 2009;15(1):34-8.
Sauven 1986 {published data only}
  • Sauven P, Playforth MJ, Smith GMR, Evans M, Pollock AV. Single-dose antibiotic prophylaxis of abdominal surgical wound infection: a trial of preoperative latamoxef against preoperative tetracycline lavage. Journal of the Royal Society of Medicine 1986;79:137-41.
Schiessel 1984 {published data only}
  • Schiessel R, Huk I, Wunderlich M, Rotter M, Wewalka G, Schemper M. Postoperative infections in colonic surgery after enteral bacitracin-neomycin-clindamycin or parenteral mezlocillin-oxacillin prophylaxis. Journal of Hospital Infection 1984;5:289-97.
Schneiders 1976 {published data only}
  • Schneiders H, Haralambie E, Towfigh H, Eigler FW, Linzenmeier G. Effectiveness of antibiotic premedication in colonic surgery [German] [Uber die Wirksamkeit der Antibioticavorbereitung in der Colonchirurgie]. Chirurg 1976;47(1):33-8.
Schoetz 1990 {published data only}
  • Schoetz DJ Jr, Roberts PL, Murray JJ, Coller JA, Veidenheimer MC. Addition of parenteral cefoxitin to regimen of oral antibiotics for elective colorectal operations. Annals of Surgery 1990;212(2):209-12.
Shatney 1984 {published data only}
  • Shatney CH. Antibiotic prophylaxis in elective gastro-intestinal tract surgery: a comparison of single-dose pre-operative cefotaxime and multiple-dose cefoxitin. Journal of Antimicrobial Chemotherapy 1984;14(Suppl B):241-5.
Shimizu 2010 {published data only}
  • Shimizu J, Ikeda K, Fukunaga M, Murata K, Miyamoto A, Umeshita K, et al. Multicenter prospective randomized phase II study of antimicrobial prophylaxis in low-risk patients undergoing colon surgery. Surgery Today 2010;40(10):954-7.
Skipper 1992 {published data only}
  • Skipper D, Karran SJ. A randomized prospective study to compare cefotetan with cefuroxime plus metronidazole as prophylaxis in elective colorectal surgery. Journal of Hospital Infection 1992;21:72-7.
Slama 1979 {published data only}
  • Slama TG, Carey LC, Fass RJ. Comparative efficacy of prophylactic cephalothin and cefamandole for elective colon surgery: results of a prospective, randomized, double-blind study. American Journal of Surgery 1979;137(5):593-6.
Solhaug 1983 {published data only}
  • Solhaug JH, Bergman L, Kylberg F. A randomized evaluation of single dose chemoprophylaxis in elective colorectal surgery - a comparison between metronidazole and doxycycline. Annals of Clinical Research 1983;15(1):15-20.
Stellato 1990 {published data only}
Stewart 1995 {published data only}
  • Stewart M, Taylor EW, Lindsay G, West of Scotland Surgical Infection Study Group. Infection after colorectal surgery: a randomised trial of prophylaxis with piperacillin versus sulbactam/pipercillin. Journal of Hospital Infection 1995;29:135-42.
Stubbs 1987 {published data only}
  • Stubbs RS, Griggs NJ, Kelleher JP, Dickinson IK, Moat N, Rimmer DMD. Single dose mezlocillin versus three dose cefuroxime plus metronidazole for the prophylaxis of wound infection after large bowel surgery. Journal of Hospital Infection 1987;9:285-90.
Suzuki 2011 {published data only}
  • Suzuki T, Sadahiro S, Maeda Y, Tanaka A, Okada K, Kamijo A. Optimal duration of prophylactic antibiotic administration for elective colon cancer surgery: A randomized, clinical trial. Surgery 2011;149(2):171-8.
Takesue 2000 {published data only}
Taylor 1994 {published data only}
Tehan 1989 {published data only}
  • Tehan S, Whittaker J. A multi-centre double-blind prospective study comparing the efficacy and tolerance of Augmentin with the combination of cephradine plus metronidazole as surgical prophylaxis. Surgical Research Communications 1989;6:97-105.
Thomas 1985 {published data only}
Tornqvist 1981 {published data only}
Tsimoyiannis 1991 {published data only}
  • Tsimoyiannis EC, Paizis JB, Kabbani K, Lekkas ET, Floras GA, Boulis SA. Short-term antibiotic prophylaxis in elective colorectal surgery. Chemotherapy 1991;91(37):66-9.
Tuchmann 1988 {published data only}
  • Tuchmann V, Breyer S, Ganzinger U. Antibiotic prophylaxis in colorectal surgery, short-term vs one-shot prophylaxis - a multicentre study. Fortschritt Medizin 1988;106(26):537-60.
Ulrich 1981 {published data only}
University 1987 {published data only}
  • University of Melbourne Colorectal Group. Systematic Timentin is superior to oral tinidazole for antibiotic prophylaxis in elective colorectal surgery. Diseases of the Colon and Rectum 1987;30(10):786-9.
University 1989 {published data only}
  • University of Melbourne Colorectal Group. A comparison of single-dose systematic Timentin with mezlocillin for prophylaxis of wound infection in elective colorectal surgery. Diseases of the Colon and Rectum 1989;32(11):940-3.
Utley 1984 {published data only}
  • Utley RJ, Macbeth WAAG. Preoperative cefoxitin. A double-blind prospective study in the prevention of wound infection. Journal of the Royal College of Surgeons of Edinburgh 1984;29(3):143-6.
Vacher 1990 {published data only}
  • Vacher B, Rodary M, Hay JM, Fingerhut A. Colorectal preparation for excision surgery. Development after 4 randomized multicenter studies [Préparation colo-rectale à la chirurgie d'exérèse. Evolution après 4 études multicentriques randomisées.]. Chirurgie; Mémoires de l'Académie de Chirurgie 1990; Vol. 116, issue 4-5:409-14.
Vallance 1980 {published data only}
  • Vallance S, Jones B, Arabi Y, Keighley MR. Importance of adding neomycin to metronidazole for bowel preparation. Journal of the Royal Society of Medicine 1980;73(4):238-40.
Vallent 1983 {published data only}
  • Vallent K, Bodnar A, Weltner J. Experience with intravenous metronidazole administration in the preoperative care of surgery of the large intestine [German] [Erfahrungen mit intravenoser Metronidazolgabe bei der Vorbereitung zu Dickdarmoperationen]. Zentralblatt fur Chirurgie 1983;108(20):1293-8.
Vargish 1978 {published data only}
  • Vargish T, Crawford LC, Stallings RA, Wasilauskas BL, Myers RT. A randomized prospective evaluation of orally administered antibiotics in operations on the colon. Surgery, Gynecology & Obstetrics 1978;146(2):193-8.
Viddal 1980 {published data only}
  • Viddal KO, Semb LS. Tinidazole and doxycycline compared to doxycycline alone as prophylactic antimicrobial agents in elective colorectal surgery. Scandinavian Journal of Gastroenterology. Supplement 1980;59:21-4.
Walker 1988 {published data only}
  • Walker AJ, Taylor EW, Lindsay G, Dewar EP. A multicentre study to compare piperacillin with the combination of netilmicin and metronidazole for prophylaxis in elective colorectal surgery undertaken in district general hospitals. Journal of Hospital Infection 1988;11(4):340-8.
Wapnick 1979 {published data only}
  • Wapnick S, Guinto R, Reizis I, LeVeen HH. Reduction of postoperative infection in elective colon surgery with preoperative administration of kanamycin and erythromycin. Surgery 1979;85(3):317-21.
Watt-Boolsen 1979 {published data only}
  • Watt-Boolsen S, Justesen T, Blichert-Toft M, Hansen JB. The prophylaxis of septic complications in colo-rectal surgery. A controlled trial of metronidazole and oxytetracycline. Acta Chirurgica Scandinavica 1979;145(4):263-6.
Weaver 1986 {published data only}
  • Weaver M, Burdon DW, Youngs DJ, Keighley MRB. Oral neomycin and erythromycin compared with single-dose systematic metronidazole and ceftriaxone prophylaxis in elective colorectal surgery. American Journal of Surgery 1986;15(1):437-41.
Weidema 1985 {published data only}
  • Weidema WF, Van Den Boogaard AE, Wesdorp RI, Van Boven CP, Greep JM. 24-hour systematic prophylaxis with gentamicin and metronidazole, or metronidazole alone, in elective colorectal surgery after mechanical bowel preparation with mannitol and whole gut irrigation. Acta Chirurgica Belgica 1985;85:349-53.
Wenzel 1982 {published data only}
  • Wenzel M, Walden M, Heinrich M, Neuhaus B. Systemic mezlocillin prophylaxis in elective colon surgery [German] [Die systemische Mezlocillin-Prophylaxe in der elektiven Kolonchirurgie]. Infection 1982;10(Suppl 3):148-57.
Wenzel 1983 {published data only}
  • Wenzel M, Schmidt C, Walden M. Systemic mezlocillin prophylaxis in elective colon surgery [Die systemische Mezlocillin Prophylaxe in der elektiven Kolonchirurgie]. Medizinische Welt 1983;34(35):934-40.
Wenzel 1983a {published data only}
  • Wenzel M, Schmidt C, Walden M. Systemic mezlocillin prophylaxis in elective colon surgery [Die systemische Mezlocillin Prophylaxe in der elektiven Kolonchirurgie]. Medizinische Welt 1983;34(35):934-40.
Wenzel 1985 {published data only}
  • Wenzel M, Heinrich M, Schmidt C. Peri-operative infection prophylaxis with ornidazole and gentamicin in elective colonic surgery. Pharmatherapeutica 1985;4(6):351-5.
Wetterfors 1980 {published data only}
  • Wetterfors J, Hoejer H. Prophylaxis with doxycycline (Vibramycin) in colorectal surgery. Scandinavian Journal of Gastroenterology. Supplement 1980;59:12-6.
Willis 1977 {published data only}
  • Willis AT, Ferguson IR, Jones PH, Phillips KD, Tearle PV, Fiddian RV, et al. Metronidazole in prevention and treatment of bacteroides infections in elective colonic surgery. British Medical Journal 1977;1(6061):607-10.
Winker 1983 {published data only}
  • Winker H, Dortenmann J, Wittmann DH. Infection prevention in elective large intestine surgery. Results of a prospective randomized comparative study. Chirurg 1983;54(4):272-7.
Wohlfahrt 1987 {published data only}
  • Wohlfahrt R, Siedek M. Perioperative infection prophylaxis in colon surgery. Chemioterapia 1987;6:603-5.
Yabata 1997 {published data only}
  • Yabata E, Okabe S, Endo M. A prospective, randomized clinical trial of preoperative bowel preparation for elective colorectal surgery-comparison among oral, systemic, and intraoperative luminal antibacterial preparations. Journal of Medical & Dental Sciences 1997;44(4):75-80.
Yip 1994 {published data only}
  • Yip AWC. Comparison of prophylactic ampicillin/sulbactam with gentamicin and metronidazole in elective colorectal surgery: A randomized clinical study. Journal of Hospital Infection 1994;27(2):149-54.
Zanella 2000 {published data only}
  • Zanella E, Rulli F and the 230 Study Group. A multicenter randomized trial of prophylaxis with intravenous cefepime + metronidazole or ceftriaxone + metronidazole in colorectal surgery. Journal of Chemotherapy 2000;12(1):63-71.
Zelenitsky 2000 {published data only}
  • Zelenitsky SA, Silverman RE, Duckworth H, Harding GKM. A prospective, randomized, double-blind study of single high dose versus multiple standard dose gentamicin both in combination with metronidazole for colorectal surgical prophylaxis. Journal of Hospital Infection 2000;46:135-40.
Zuber 1989 {published data only}
  • Zuber M, Durig M, Neff U, Laffer U. Antibiotic prophylaxis in colorectal surgery: cefazolin-ornidazole versus cefazolin-placebo [German]. Helvetica Chirurgica Acta 1989;56:211-5.

References to studies excluded from this review

  1. Top of page
  2. Abstract
  3. Summary of findings
  4. Background
  5. Objectives
  6. Methods
  7. Results
  8. Discussion
  9. Authors' conclusions
  10. Acknowledgements
  11. Data and analyses
  12. Appendices
  13. Feedback
  14. What's new
  15. History
  16. Contributions of authors
  17. Declarations of interest
  18. Sources of support
  19. Differences between protocol and review
  20. Notes
  21. Characteristics of studies
  22. References to studies included in this review
  23. References to studies excluded from this review
  24. References to studies awaiting assessment
  25. Additional references
  26. References to other published versions of this review
Anonymous 1988 {published data only}
  • Anonymous. Infectious problems in elective non-colorectal abdominal surgery. The Norwegian Gastro-Intestinal Group (NORGAS). Current Medical Research and Opinion 1988;11(3):159-70.
Baker 1994 {published data only}
Baracs 2011 {published data only}
  • Baracs J, Huszar O, Sajjadi S.G, Peter Horvath O. Surgical site infections after abdominal closure in colorectal surgery using triclosan-coated absorbable suture (PDS Plus) vs. uncoated sutures (PDS II): A randomized multicenter study. Surgical Infections 2011;12(6):483-9.
Bartlett 1983 {published data only}
Bennett-Guerrero 2010 {published data only}
  • Bennett-Guerrero E, Pappas TN, Koltun WA, Fleshman JW, Lin M, Garg J, et al. Gentamicin-collagen sponge for infection prophylaxis in colorectal surgery. New England Journal of Medicine 2010;363(11):1038-49.
Burdon 1977 {published data only}
  • Burdon JG, Morris PJ, Hunt P, Watts JM. A trial of cephalothin sodium in colon surgery to prevent wound infection. Archives of Surgery 1977;112(10):1169-73.
Burton 1975 {published data only}
Cazzaniga 1980 {published data only}
  • Cazzaniga A, Perazzoli G, Boerchi A. Use of oral antibiotics association in elective colon surgery [L'uso di associazioni antibiotiche nella preparazione orale del colon all'intervento chirurgico. Confronto tra neomicina-eritromicina e neomicina-tetraciclina]. Chirurgia 1980;4(1):103-13.
Champault 1981 {published data only}
  • Champault G. Pre-operative preparation of the colon: A controlled prospective multicentre study in 215 patients [La preparation colique a la chirurgie. Etude multicentrique prospective controlee (215 cas)]. Journal de Chirurgie 1981;118(11):677-84.
Charalambous 2003 {published data only}
  • Charalambous C, Tryfonidis M, Swindell R, Lipsett AP. When should old therapies be abandoned? A modern look at old studies on topical ampicillin. Journal of Infection 2003;47(3):203-9.
Claesson 1981 {published data only}
  • Claesson B, Brandberg A, Brevinge H. Selective postoperative antibiotic prophylaxis in colo-rectal surgery on the basis of bacterial concentration in the operative field. Acta Chirurgica Scandinavica 1981;147:289-93.
Cleary 1998 {published data only}
  • Cleary RK, Grossmann R, Fernandez FB, Stull TS, Fowler JJ, Walters MR, et al. Metronidazole may inhibit intestinal colonization with Clostridium difficile. Diseases of the Colon and Rectum 1998;41(4):464-7.
Davey 1995 {published data only}
  • Davey PG, Parker SE, Crombie IK, Jaderberg M. The cost effectiveness of amoxicillin/clavulanic acid as antibacterial prophylaxis in abdominal and gynaecological surgery. Pharmacoeconomics 1995;7(4):347-56.
Davey 1998 {published data only}
  • Davey PG, Nathwani D. What is the value of preventing postoperative infections?. New Horizons 1998;6(2 Suppl):64-71.
De Lalla 2009 {published data only}
  • De Lalla F. Antimicrobial prophylaxis in colorectal surgery: Focus on ertapenem. Therapeutics and Clinical Risk Management 2009;5(1):829-39.
Devecioglu 1990 {published data only}
  • Devecioglu S, Tuylu Y, Zissis NP. Piperacillin prophylaxis in colorectal surgery. A randomized comparative evaluation of two dosage schedules. Saudi Medical Journal 1990;11(5):385-8.
Dionigi 1989 {published data only}
  • Dionigi R, Mozzillo N, Ventriglia L. Comparative multicenter study on efficacy and safety of aztreonam and gentamicin in prophylaxis of high-risk colorectal surgery. Journal of Chemotherapy (Florence, Italy) 1989;1(Suppl 2):22-7.
Eisenberg 1981 {published data only}
Feathers 1977 {published data only}
Fielding 1985 {published data only}
  • Fielding G. Antibiotic prophylaxis in elective colorectal anastomosis - cefoxitin 2g vs moxalactam 1g [abstract]. Proceedings of the Division of Surgery of the Royal Brisbane Hospital. 1985:46.
Galandiuk 1989 {published data only}
  • Galandiuk S, Polk HCJ, Jagelman DG, Fazio VW. Re-emphasis of priorities in surgical antibiotic prophylaxis. Surgery Gynecology and Obstetrics 1989;169(3):219-22.
Gardini 1990 {published data only}
  • Gardini G, Bernabe A, Guglielminetti D, Campanini A, Orselli F, Dell'Amore D, et al. Aztreonam and clindamycin in short-term antibiotic prophylaxis in colorectal surgery: results of a multicenter studies [Aztreonam e clindamicina nella profilassi antibiotica a breve termine in chirurgia colorettale: risultati di uno studio policentrico]. Il Giornale di Chirurgia 1990;11(11-12):643-6.
Goldstein 2009 {published data only}
  • Goldstein EJC, Citron DM, Merriam CV, Abramson MA. Infection after elective colorectal surgery: bacteriological analysis of failures in a randomized trial of cefotetan vs. ertapenem prophylaxis. Surgical Infections 2009;10(2):111-8.
Gomez-Alonso 1984 {published data only}
  • Gomez-Alonso A, Lozano F, Perez A, Almazan A, Abdel-Lah A, Cuadrado F. Systematic prophylaxis with gentamicin-metronidazole in appendicectomy and colorectal surgery: a prospective controlled clinical study. International Surgery 1984;69(1):17-20.
Greig 1987 {published data only}
  • Greig J, Morran C, Gunn R, Mason B, Sleigh D, McArdle C. Wound sepsis after colorectal surgery: the effect of cefotetan lavage. Chemioterapia 1987;6(2):595-6.
Grundmann 1989 {published data only}
  • Grundmann R, Kolschbach D. Perioperative antibiotic prophylaxis in colorectal surgery - A randomized controlled clinical trial [Perioperative Antibiotikaprophylaxe bei kolorektalen Eingriffen under optimalen und suboptimalen Bedingungen - eine prospektiv-randomisierte Studie]. Aktuelle Chirurgie 1989;24(4):148-53.
Hall 1987 {published data only}
  • Hall J, Chleboun J, Mander J. Re: The use of prophylactic antibiotics in colorectal surgery: a prospective trial. Journal of the Royal College of Surgeons of Edinburgh 1987;32(2):126.
Hancke 1980 {published data only}
  • Hancke E, Stelzner F. Preoperative prophylactic antibiotics reduce septic complications of colorectal operations [Praoperative Antibioticaprophylaxe reduziert septische Komplikationen bei Colon- und Rectumeingriffen]. Langenbecks Archiv fur Chirurgie 1980;353(1):71-4.
Hares 1981 {published data only}
  • Hares MM, Greca F, Youngs D, Bentley S, Burdon DW, Keighley MR. Failure of antimicrobial prophylaxis with cefoxitin, or metronidazole and gentamicin in colorectal surgery. Is mannitol to blame?. Journal of Hospital Infection 1981;2(2):127-33.
Hashizume 2004 {published data only}
  • Hashizume T, Nishizawa R, Aizawa S, Yamaya M, Kobori H, Asakura Y, et al. Clinical study of using prophylactic antibiotics and chemical preparation for elective operation of colorectal cancer. Japanese Journal of Gastroenterological Surgery 2004;37(4):375-83.
Hesselfeldt 1988 {published data only}
  • Hesselfeldt P, Raahave D, Pedersen T, Zachariassen A, Kann D, Hansen OH. Preventive local ampicillin and intravenous cephotaxime in colorectal surgery [Lokal ampicillin og i.v. cefotaxim som profylakse ved kolorektal kirurgi]. Ugeskrift for Laeger 1988;150(23):1406-8.
Higgins 1980 {published data only}
Höjer 1978a {published data only}
Höjer 1981 {published data only}
  • Höjer H, Brote L, Nystrom PO, Wetterfors J. Systemic prophylaxis in colorectal surgery: A comparison between tinidazole and doxycycline. Scandinavian Journal of Infectious Diseases 1981;13(Suppl 26):75-8.
Howard 2009 {published data only}
  • Howard DD, White CQ, Harden TR, Ellis CN. Incidence of surgical site infections postcolorectal resections without preoperative mechanical or antibiotic bowel preparation. American Surgeon 2009;75(8):659-63.
Hulbert 1967 {published data only}
  • Hulbert J, Blair DW. One-day kanamycin regime for pre-operative bowel preparation. Postgraduate Medical Journal 1967;Suppl:27-36.
Isbister 1986 {published data only}
  • Isbister WH. The use of prophylactic antibiotics in colorectal surgery: a prospective trial. Journal of the Royal College of Surgeons of Edinburgh 1986;31(5):284-8.
Ishibashi 2009 {published data only}
  • Ishibashi K, Kuwabara K, Ishiguro T, Ohsawa T, Okada N, Miyazaki T, et al. Short-term intravenous antimicrobial prophylaxis in combination with preoperative oral antibiotics on surgical site infection and methicillin-resistant Staphylococcus aureus infection in elective colon cancer surgery: results of a prospective randomized trial. Surgery Today 2009;39(12):1032-9.
Jewesson 1997 {published data only}
  • Jewesson P, Chow A, Wai A, Frighetto L, Nickoloff D, Smith J, et al. A double-blind, randomized study of three antimicrobial regimens in the prevention of infections after elective colorectal surgery. Diagnostic Microbiology & Infectious Disease 1997;29(3):155-65.
Jostarndt 1981 {published data only}
  • Jostarndt L, Thiede A, Sonntag HG, Hamelmann H. Systemic antibiotic prophylaxis in elective colon surgery. Results of a controlled study [Die systemische Antibioticumprophylaxe in der elektiven Colonchirurgie. Ergebnisse einer kontrollierten Studie]. Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen 1981;52(6):398-402.
Juul 1985 {published data only}
  • Juul P, Merrild U, Kronborg O. Topical ampicillin in addition to a systematic antibiotic prophylaxis in elective colorectal surgery: a prospective randomised study. Diseases of the Colon and Rectum 1985;28(11):804-6.
Keighley 1975 {published data only}
Khandelwal 2011 {published data only}
  • Khandelwal M, Ewart E, Kaur G, Moore PJ. Perineal wound healing is significantly improved with the use of collatamp. Wound Repair and Regeneration Vol. Conference: 21st Annual Meeting of the European Tissue Repair Society Amsterdam Netherlands. Conference Start: 20111005 Conference End: 20111007.
Kronberger 1981 {published data only}
  • Kronberger L, Kraft-Kinz J. Prevention of septic complications in colorectal surgery (author's transl) [Zur Verhinderung von septischen Komplikationen nach Dickdarm- und Mastdarmoperationen]. Wiener Medizinische Wochenschrift (1946) 1981;131(8):209-11.
Kugel 1979 {published data only}
  • Kugel E, Mad H, Esch PM. Effect of preoperative paromomycin therapy on the course of wound healing after colonic intervention. A prospective blind study [Der Einfluss praoperativer Paromomycin-Therapie auf den Wundheilungsverlauf nach Eingriffen am Dickdarm. Eine prospektive Blindstudie]. Fortschritte der Medizin 1979;97(32):1382-4.
Kujath 1984 {published data only}
  • Kujath P, Bruch HP, Schmidt E, Doell W. Perioperative prophylaxis in elective colorectal surgery [Untersuchung zur perioperativen prophylaxe in der electiven colorectalen chirurgie]. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen 1984;55:519-22.
Kusche 1981 {published data only}
  • Kusche J, Stahlknecht CD. Antibiotic prophylaxis in colorectal surgery: is there a drug of choice? [German] [Antibioticaprophylaxe bei colorectalen Operationen: Gibt es ein Mittel der Wahl?]. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen 1981;52(9):577-85.
Liao 2008 {published data only}
  • Liao XJ, Zhang W, Meng RG, Wang H, Lou Z, Fu CG. Prophylactic use of antibiotics in selective colorectal operation: a randomized controlled trial [Chinese]. Chung-Hua Wai Ko Tsa Chih [Chinese Journal of Surgery] 2008;46(2):122-4.
Lohsiriwat 2009 {published data only}
  • Lohsiriwat V, Lohsiriwat D. Antibiotic prophylaxis and incisional surgical site infection following colorectal cancer surgery: An analysis of 330 cases. Journal of the Medical Association of Thailand 2009;92(1):12-6.
Mendes 1992 {published data only}
  • Mendes da Costa P, Kaufman L. Amikacin once daily plus metronidazole versus amikacin twice daily plus metronidazole in colorectal surgery. Hepato-Gastroenterology 1992;39(4):350-4.
Mittelkotter 2001 {published data only}
  • Mittelkotter U, Rau HG, Thiede A, Schildberg FW, Kullmann KH. Perioperative antimicrobial prophylaxis for colonic surgery: Present status in Germany. A prospective multicenter study with and without Metronidazole. Zentralblatt für Chirurgie 2001;126(10):799-804.
Montorsi 1997 {published data only}
  • Montorsi W, Germiniani R. Pefloxacin versus ceftriaxone in single-dose antibiotic prophylaxis in general clean-contaminated surgery. The Pefloxacin Study Group. Minerva Chirurgica 1997;52(12):1539-48.
Moore 1989 {published data only}
  • Moore FA, Moore EE, Ammons LA, McCroskey BL. Presumptive antibiotics for penetrating abdominal wounds. Surgery, Gynecology & Obstetrics 1989;169(2):99-103.
Msika 1999 {published data only}
  • Msika S, Kianmanesh R, Villar F, Denet C, Sledzianowski JF. IV antibioprophylaxy induction (ceftriaxone + ornidazole) leading up or not of a quick oral action antibiotic preparation in postoperative septic complication prophylaxy in colorectal surgery. A multicentric controlled study [L'antibioprophylaxie IV d'induction (ceftriaxione + ornidazole) precedee ou non d'une preparation antibiotique orale d'action rapide dans la prophylaxie des complications septiques postoperatoires en chirurgie colorectale. Essai controle multicentrique.]. Annales de Chirurgie 1999;53(7):664-5.
Nash 1967 {published data only}
Nichols 1972 {published data only}
Nowacki 2005 {published data only}
  • Nowacki MP, Rutkowski A, Oledzki J, Chwalinski M. Prospective, randomized trial examining the role of gentamycin-containing collagen sponge in the reduction of postoperative morbidity in rectal cancer patients: early results and surprising outcome at 3-year follow-up. International Journal of Colorectal Disease 2005;20(2):114-20.
Nowak 1982 {published data only}
  • Nowak W, Erbe HJ. Wound infection prophylaxis in colonic and rectal surgery with metronidazole and neomycin - a prospective study. Zentralblatt für Chirurgie 1982;107(13):763-7.
Olsson-Liljequist 1993 {published data only}
  • Olsson-Liljequist B, Burman LG. Introducing fosfomycin for surgical prophylaxis - emergence of resistance in aerobic faecal gram-negative bacteria of in-patients, but not among strains causing infection after elective colorectal procedures. Scandinavian Journal of Infectious Diseases 1993;25(6):725-33.
Paladino 1994 {published data only}
  • Paladino JA, Rainstein MA, Serrianne DJ, Przylucki JE, Welage LS, Collura ML, et al. Ampicillin-sulbactam versus cefoxitin for prophylaxis in high-risk patients undergoing abdominal surgery. Pharmacotherapy 1994;14(6):734-9.
Palmer 1994 {published data only}
  • Palmer BV, Mannur KR, Ross WB. An observer blind trial of co-amoxiclav versus cefuroxime plus metronidazole in the prevention of postoperative wound infection after general surgery. Journal of Hospital Infection 1994;26:287-92.
Polk 1974 {published data only}
  • Polk HC Jr. Editorial: Diminished surgical infection by systemic antibiotic administration in potentially contaminated operations. Surgery 1974;75(2):312-4.
Polk 1977 {published data only}
Pollock 1978 {published data only}
  • Pollock AV, Arnot RS, Leaper DJ, Evans M. The role of antibacterial preparation of the intestine in the reduction of primary wound sepsis after operations on the colon and rectum. Surgery, Gynecology & Obstetrics 1978;147(6):909-12.
Pollock 1985 {published data only}
  • Pollock AV. A high incidence of bleeding is observed in a trial to determine whether addition of metronidazole is needed with latamoxef for prophylaxis in colorectal surgery. Journal of Hospital Infection 1985;6(3):353-6.
Quendt 1996 {published data only}
  • Quendt J, Blank I, Seidel W. Perioperative antibiotic prophylaxis by transperitoneal and subcutaneous application during elective colorectal surgery. A prospective randomized comparative study [Peritoneale und subkutane Applikation von Cefazolin als perioperative Antibiotikaprophylaxe bei kolorektalen Operationen. Prospektive randomisierte Vergleichsstudie bei 200 Patienten]. Langenbecks Archiv fur Chirurgie 1996;381(6):318-22.
Raahave 1981 {published data only}
Raahave 1988 {published data only}
Raahave 1989 {published data only}
  • Raahave D, Hesselfeldt P, Pedersen T, Zachariassen A, Kann D, Hansen OH. No effect of topical ampicillin prophylaxis in elective operations of the colon or rectum. Surgery, Gynecology & Obstetrics 1989;168:112-4.
Rasic 2011 {published data only}
  • Rasic Z, Schwarz D, Adam VN, Sever M, Lojo N, Rasic D, et al. Efficacy of antimicrobial triclosan-coated polyglactin 910 (Vicryl* Plus) suture for closure of the abdominal wall after colorectal surgery. Collegium Antropologicum 2011;35(2):439-43.
Rau 2000 {published data only}
  • Rau HG, Mittelkotter U, Zimmermann A, Lachmann A, Kohler L, Kullmann KH. Perioperative infection prophylaxis and risk factor impact in colon surgery. Chemotherapy 2000;46(5):353-63.
Reddy 2007 {published data only}
Reith 1996 {published data only}
  • Reith HB, Mittelkotter U, Niedmann M, Debus S, Kozuschek W. Modification of laparotomy wound healing in colon surgery by local antibiotic administration [Beeinflussung der Laparotomiewundheilung in der Kolonchirurgie durch lokale Antibiotikaapplikation]. Zentralblatt fur Chirurgie 1996;121 Suppl:84-5.
Rohwedder 1993 {published data only}
  • Rohwedder R, Bonadeo F, Benati M, Ojea Quintana G, Schlecker H, Vaccaro C. Single-dose oral ciprofloxacin plus parenteral metronidazole for perioperative antibiotic prophylaxis in colorectal surgery. Chemotherapy 1993;39(3):218-24.
Rosen 1991 {published data only}
  • Rosen HR, Marczell AP, Czerwenka E, Stierer MO, Spoula H, Wasl H. Local gentamicin application for perineal wound healing following abdominoperineal rectum excision. American Journal of Surgery 1991;162(5):438-41.
Ruiz-Tovar 2012 {published data only}
  • Ruiz-Tovar J, Santos J, Arroyo A, Llavero C, Armaanzas L, Lopez-Delgado A, et al. Effect of peritoneal lavage with clindamycin-gentamicin solution on infections after elective colorectal cancer surgery. Journal of the American College of Surgeons 2012;214(2):202-7.
Rutten 1997 {published data only}
  • Rutten HJ, Nijhuis PH. Prevention of wound infection in elective colorectal surgery by local application of a gentamicin-containing collagen sponge. European Journal of Surgery. Supplement 1997;578:31-5.
Salem 1987 {published data only}
  • Salem RR, McIndoe A, Matkin JA, Lidou AC, Clarke A, Wood CB. The hematologic effects of latamoxef sodium when used as a prophylaxis during surgical treatment. Surgery, Gynecology & Obstetrics 1987;164(6):525-9.
Salvati 1988 {published data only}
  • Salvati EP, Rubin RJ, Eisenstat TE, Bohman H. Value of subcutaneous and intraperitoneal antibiotics in reducing infection in clean contaminated operations of the colon. Surgery, Gynecology and Obstetrics 1988;167(4):315-8.
Scheibel 1978 {published data only}
  • Scheibel JH, Lykkegaard Nielsen M, Wamberg T. Septic complications in colo-rectal surgery after 24 hours versus 60 hours of preoperative antibiotic bowel preparation. II. Significance of bacterial concentrations in the bowel for contamination of the operation field and subsequent wound infection. Acta Chirurgica Scandinavica 1978;144(7-8):527-32.
Scher 1997 {published data only}
Shinagawa 1987 {published data only}
  • Shinagawa N, Fukui T, Mizuno H, Ishikawa M, Hosono S, Mashita K, et al. A prospective randomized trial to compare moxalactam and cefmetazole as prophylactics in elective colorectal operations. Chemotherapy 1987;35(11):833-8.
Silva 1989 {published data only}
  • Silva M, Cornick NA, Gorbach SL. Suppression of colonic microflora by cefoperazone and evaluation of the drug as potential prophylaxis in bowel surgery. Antimicrobial Agents and Chemotherapy 1989;33:835-8.
Sortini 1991 {published data only}
  • Sortini A, Liguori G, Bardini R, Infantino A, Carrella G, Asolati A. Infectious chemoprophylaxis in colorectal surgery. A multicenter study of imipenem-cilastatin vs. cefuroxime and metronidazole or cefotetan [Chemioprofilassi infettiva in chirurgia colo-rettale. Studio policentrico su imipenem-cilastatina vs. cefuroxime e metronidazolo o cefotetan]. Il Giornale di Chirurgia 1991;12(6-7):393-5.
Spence 1984 {published data only}
  • Spence RA, Anderson JR, Parks TG. The use of gentamicin-PMMA chains in colorectal surgery. British Journal of Clinical Practice 1984;38(7-8):252-4.
Takesue 2009 {published data only}
  • Takesue Y, Hirata A, Kobayashi M, Yamagishi D, Matsuoka H, Tanaka K, et al. Bowel preparation with oral antibiotics for the surgery in patients with ulcerative colitis (UC) and colorectal cancer (CRC): Prospective, randomized study. Surgical Infections. Conference: 3rd Combined Meeting of the Surgical Infection Societies of North America and Europe 2009.
Tanner 1986 {published data only}
Taylor 1979 {published data only}
Tudor 1988 {published data only}
  • Tudor RG, Haynes I, Youngs DJ, Burdon DW, Keighley MRB. Comparison of short-term antibiotic cover with a third-generation cephalosporin against conventional five-day therapy using metronidazole with an aminoglycoside in emergency and complicated colorectal surgery. Diseases of the Colon and Rectum 1988;31(1):28-32.
Tweed 2005 {published data only}
  • Tweed C. Prevention of surgical wound infection: prophylactic antibiotics in colorectal surgery. Journal of Wound Care 2005;14(5):202-5.
University 1986 {published data only}
  • University of Melbourne Colorectal Group. Clinical trial of prophylaxis of wound sepsis in elective colorectal surgery comparing tiacarcillin with tinidazole. Australian and New Zealand Journal of Surgery 1986;56:209-13.
Vanderveken 1991 {published data only}
  • Vanderveken M, Schepens M, Gerard Y. Prophylactic use of a single dose of tobramycin in elective colorectal surgery. International Surgery 1991;76(2):127-30.
Wainer 1992 {published data only}
  • Wainer S, Cooper PA, Funk E, Bental RY, Sandler DA, Patel J. Prophylactic miconazole oral gel for the prevention of neonatal fungal rectal colonization and systemic infection. Pediatric Infectious Disease Journal 1992;11(9):713-6.
Wolff 1988 {published data only}
  • Wolff BG, Beart RW, Dozois RR, Pemberton JH, Zinsmeister AR, Ready RL, et al. A new bowel preparation for elective colon and rectal surgery. A prospective, randomized clinical trial. Archives of Surgery 1988;123(7):895-900.
Woodfield 2003 {published data only}
  • Woodfield JC, Van Rij AM, Pettigrew RA, Van der Linden AJ, Solomon C, Bolt D. A comparison of the prophylactic efficacy of ceftriaxone and cefotaxime in abdominal surgery. American Journal of Surgery 2003;185:45-9.
Woodfield 2009 {published data only}
  • Woodfield JC, Beshay N, van Rij AM. A meta-analysis of randomized, controlled trials assessing the prophylactic use of ceftriaxone. A study of wound, chest, and urinary infections. World Journal of Surgery 2009;33(12):2538-50.

References to studies awaiting assessment

  1. Top of page
  2. Abstract
  3. Summary of findings
  4. Background
  5. Objectives
  6. Methods
  7. Results
  8. Discussion
  9. Authors' conclusions
  10. Acknowledgements
  11. Data and analyses
  12. Appendices
  13. Feedback
  14. What's new
  15. History
  16. Contributions of authors
  17. Declarations of interest
  18. Sources of support
  19. Differences between protocol and review
  20. Notes
  21. Characteristics of studies
  22. References to studies included in this review
  23. References to studies excluded from this review
  24. References to studies awaiting assessment
  25. Additional references
  26. References to other published versions of this review
Mecchia 2000 {published data only}
  • Mecchia P. Comparative study of ceftriaxone versus cefazolin plus clindamycin as antibiotic prophylaxis in elective colorectal surgery. Journal of Chemotherapy (Florence, Italy) 2000;12 Suppl 3:5-9.
Mohri 1994 {published data only}
  • Mohri N, Ishihara H, Ito K, Hisada M, Mashita K, Mizuno A, et al. Prophylactic antibiotics in patients undergoing elective colorectal surgery: A prospective randomized study of ceftazidime and sulbactam/cefoperazone. Chemotherapy 1994;42(2):214-7.

Additional references

  1. Top of page
  2. Abstract
  3. Summary of findings
  4. Background
  5. Objectives
  6. Methods
  7. Results
  8. Discussion
  9. Authors' conclusions
  10. Acknowledgements
  11. Data and analyses
  12. Appendices
  13. Feedback
  14. What's new
  15. History
  16. Contributions of authors
  17. Declarations of interest
  18. Sources of support
  19. Differences between protocol and review
  20. Notes
  21. Characteristics of studies
  22. References to studies included in this review
  23. References to studies excluded from this review
  24. References to studies awaiting assessment
  25. Additional references
  26. References to other published versions of this review
Baeckhed 2005
Baker 2002
  • Baker SG, Kramer BS. The transitive fallacy for randomised trials: if A bests B and B bests C in separate trials, is A better than C. BMC Medical Research Methodology 2002;2:13.
Baum 1981
  • Baum ML, Anish DS, Chalmers TC, Sacks HS, Smith H Jr, Fagerstrom RM. A survey of clinical trials of antibiotic prophylaxis in colon surgery: evidence against further use of no-treatment controls. New England Journal of Medicine 1981;305:795-9.
Bellows 2011
  • Bellows CF, Mills KT, Kelly TN, Gagliardi G. Combination of oral non-absorbable and intravenous antibiotics versus intravenous antibiotics alone in the prevention of surgical site infections after colorectal surgery: a meta-analysis of randomized controlled trials. Techniques in Coloproctology 2011;15(4):385-95.
Bratzler 2005
  • Bratzler DW, Houck PM, Richards C, Steele L, Dellinger EP, Fry DE, et al. Use of antimicrobial prophylaxis for major surgery: baseline results from the National Surgical Infection Prevention Project. Archives of Surgery 2005;140(2):174-82. [MEDLINE: 15724000]
Businger 2011
  • Businger A, Grunder G, Guenin MO, Ackermann C, Peterli R, von Flüe M. Mechanical bowel preparation and antimicrobial prophylaxis in elective colorectal surgery in Switzerland -a survey. Langenbeck's Archives of Surgery 2011;396(1):107-13.
Englesbe 2010
  • Englesbe MJ, Brooks L, Kubus J, Luchtefeld M, Lynch J, Senagore A, et al. A statewide assessment of surgical site infection following colectomy: the role of oral antibiotics. Annals of Surgery 2010;252(3):514-9.
Gorbach 1991
  • Gorbach SL. Antimicrobial prophylaxis for appendectomy and colorectal surgery. Reviews of Infectious Diseases 1991;13(Suppl 10):815-20. [MEDLINE: 1754791]
Guenaga 2011
Kirkland 1999
  • Kirkland KB, Briggs JP, Trivette SL, Wilknson WE, Sexton DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization and extra costs. Infection Control and Hospital Epidemiology 1999;20(11):725-30. [MEDLINE: 10580621]
Krapohl 2011
  • Krapohl GL, Phillips LR, Campbell DA Jr, Hendren S, Banerjee M, Metzger B, et al. Bowel preparation for colectomy and risk of Clostridium difficile infection. Diseases of the Colon and Rectum 2011;54(7):810-7.
Mahmoud 2009
  • Mahmoud NN, Turpin RS, Yang G, Saunders WB. Impact of surgical site infection on length of stay and costs of colorectal and small bowel procedures. Surgical Infections 2009;10(6):539-44.
Medical Letter 2012
  • Anonymous. Antimicrobial prophylaxis for surgery. Medical Letter 2012;10(122):73-78.
Nelson 2003
  • Nelson R, Singer M. Primary repair for penetrating colon injuries. Cochrane Database of Systematic Reviews 2003, Issue 3. [DOI: 10.1002/14651858.CD002247]
Nelson 2011
Nespoli 2004
  • Nespoli A, Gianotti L, Totis M, Bovo G, Nespoli L, Chiodini P, et al. Correlation between postoperative infections and long-term survival after colorectal resection for cancer. Tumori 2004;90(5):485-90. [MEDLINE: 15656334]
Pollock 1987
  • Pollock A. Chapter 27. Surgical Infections. Edward Arnold (Publishers) Ltd, 1987.
Smith 2004
Song 1998
  • Song F, Glenny AM. Antimicrobial prophylaxis in colorectal surgery: a systematic review of randomised controlled trials. Health Technology Assessment 1998; Vol. 2, issue 7:1-110.