ANTIBIOTIC PROPHYLAXIS IN ELECTIVE COLORECTAL SURGERY

Abstract

Antibiotic administration in elective colorectal surgery is established in preventing wound infection. However, surgeons may have a tendency to prolong the administration of prophylactic antibiotic therapy in the postoperative period. The aim of this study was to elucidate the pattern of prophylactic antibiotic utilisation in elective colorectal surgery and to determine if evidence based medicine was employed in relation to this practice. A cross sectional study encompassing general surgeons performing elective colorectal surgery was performed. Questionnaires were distributed to 144 surgeons (national, academic and private healthcare). Questions pertaining to the type, timing and duration of antibiotic administration were assessed. The prevalence of wound infection audit rate and the presence of specific guidelines related to antibiotic administration were also determined. The response rate obtained was 67% (n = 96). Although evidence from the current medical literature and recommended national guidelines support the use of single dose prophylactic antibiotics, 72% of the respondents employed more than a single dose. Forty surgeons (42%) claimed that their prescribing practice was supported by the medical literature, 31 respondents (32%) based their practice on hospital guidelines and personal preference was cited as a reason by 21 surgeons (22%). The remaining four respondents (4%) used similar scheduling policy as practiced by their colleagues in relation to antibiotic administration. Twenty‐five percent of respondents audited their wound infection rate for elective colorectal surgery. There was no significant difference in antibiotic dose scheduling between national, private and university academic institutions. χ2 = 0.315 (P = 0.854). The above results suggest that a significant proportion of surgeons administer excessive and unnecessary doses of antibiotics in elective colorectal surgery. Further studies are required to uncover the exact reasons but lack of appropriate guidelines and failure to exercise evidence based medicine are major factors that account for this practice.