The Role of Perioperative Antibiotics in Colorectal Surgery

Abstract

After more than the 60 years since the first report of antibiotic use for prevention of infection following colorectal surgery, the knowledge base has increased dramatically. Despite this expansion of knowledge, the appropriate use of prophylactic antibiotics remains controversial. Options include intravenous antibiotics, oral antibiotics, or both. The available data support concomitant use of oral and intravenous antibiotics and, perhaps more importantly, appropriate timing of the intravenous antibiotics within 2 hours (or less) of surgery start time. In selecting an oral antibiotic regime, it is imperative that both aerobic and anaerobic activities are present in the antibiotics used (i.e., neomycin plus metronidazole or erythromycin base). If a parenteral antibiotic is used without a combination of an oral antimicrobial, it must adhere to the same broad-spectrum coverage of both aerobes and anaerobes. Oral agents should be administered in limited doses the day before the operation. Parenteral antibiotics must be administered in a timely fashion to ensure that adequate tissue levels are present at the time of the incision and be of adequate duration to produce adequate tissue levels during the expected duration of contamination