分子薬学および有機プロセス研究ジャーナル

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Antibiotic Prophylaxis in Colorectal Surgery: Evolving Trends

Peter A Ongom and Stephen C Kijjambu

Introduction: Surgical antibiotic prophylaxis has become standard practice for patients undergoing colorectal surgery. This clinical practice has changed greatly over the last three decades, and it is currently accepted worldwide. It is phenomenal in minimizing postoperative wound infection in elective surgery. Clinical practice guidelines have been developed to herald this. However, the practice is yet to be established in some regions, particularly lowincome countries. A review of the evolution of the practice is necessary.

Clinical Overview: Being a clean-contaminated procedure, colorectal surgery is a typical indication for antibiotic prophylaxis. The antibiotic for use is chosen on the basis of – its activity against endogenous flora likely to be encountered, its toxicity, and its cost, in that order. Controversy persists concerning the route of administration (oral, intravenous, or both), the number of administrations, and the duration of prophylaxis. Potent antibiotics used for serious infections are essentially not used for this purpose. A maximum dose is given preoperatively so that effective tissue concentration is present at and after the time of incision. In the absence of infection, the antibiotic is discontinued after the operative day.

Systematic improvements in the timing of initial administration, the appropriate choice of antibiotic agents, and shorter durations of administration have added value to the practice, with reductions in postoperative surgical infections, especially surgical site infections, for colorectal (clean-contaminated) procedures. The prevention of surgical site infections is an objective contained in the WHO Guidelines for Safe Surgery. They are a potentially morbid and costly complication following major colorectal surgery.

Conclusions: The practice of prophylaxis in surgery continues to improve. In recent years, growing attention is being placed on the accurate identification and monitoring of surgical complications and their costs. Advancements in antibiotic development and usage will translate into better prophylactic measures, which alongside other measures for control of surgical infections will give a better outcome for colorectal surgery.