Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1980 Aug;192(2):221–226. doi: 10.1097/00000658-198008000-00016

The influence of oral versus parenteral preoperative metronidazole on sepsis following colon surgery.

Y M Dion, G K Richards, J J Prentis, E J Hinchey
PMCID: PMC1344857  PMID: 6996626

Abstract

The incidence of wound infection following surgery on the colon is reduced by the preoperative adminstration of appropriate antibiotics. Quantitative bacteriologic studies raise the fundamental question as to whether effective antibiotic prophylaxis results from reduction of the bacterial content of the gut prior to surgery or whether effective tissue levels of the antibiotic is the key factor. Oral neomycin and metronidazole have been shown to markedly reduce the incidence of wound infection following colon surgery. A prospective randomized double-blind clinical trial was undertaken to compare the effectiveness of intravenous metronidazole (high tissue level) with oral administration (tissue and gut activity) on the incidence of wound infection. There was no difference in wound infection rates between the two groups of patients. Surprisingly, there was a significant reduction in the bacteroides content in the colon of patients who received intravenous metronidazole one hour before operation to a level almost equal to that achieved by the administration of the drug for two days by mouth before operation. Metronidazole levels in the colon at the time of surgery were comparable for both groups. The median time for recolonization of the colon was six days for the oral group, and four days for the intravenous group. Although peritoneal fluid contained significant numbers of coliforms and enterococci, clinical infection did not occur. These data suggest that systemic antibiotics effective against anerobic flora of the colon markedly reduce postoperative septic complications.

Full text

PDF

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bentley D. W., Nichols R. L., Condon R. E., Gorbach S. L. The microflora of the human ileum and intrabdominal colon: results of direct needle aspiration at surgery and evaluation of the technique. J Lab Clin Med. 1972 Mar;79(3):421–429. [PubMed] [Google Scholar]
  2. Bodner S. J., Koenig M. G., Goodman J. S. Bacteremic Bacteroides infections. Ann Intern Med. 1970 Oct;73(4):537–544. doi: 10.7326/0003-4819-73-4-537. [DOI] [PubMed] [Google Scholar]
  3. Brass C., Richards G. K., Ruedy J., Prentis J., Hinchey E. J. The effect of metronidazole on the incidence of postoperative wound infection in elective colon surgery. Am J Surg. 1978 Jan;135(1):91–96. doi: 10.1016/0002-9610(78)90016-8. [DOI] [PubMed] [Google Scholar]
  4. Eykyn S. J., Phillips I. Metronidazole and anaerobic sepsis. Br Med J. 1976 Dec 11;2(6049):1418–1421. doi: 10.1136/bmj.2.6049.1418. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Feathers R. S., Sagor G. R., Lewis A. A., Amirak I. D., Noone P. Prophylactic systemic antibiotics in colorectal surgery. Lancet. 1977 Jul 2;2(8027):4–8. doi: 10.1016/s0140-6736(77)90003-4. [DOI] [PubMed] [Google Scholar]
  6. Goldring J., McNaught W., Scott A., Gillespie G. Prophylactic oral antimicrobial agents in elective colonic surgery. A controlled trial. Lancet. 1975 Nov 22;2(7943):997–1000. doi: 10.1016/s0140-6736(75)90289-5. [DOI] [PubMed] [Google Scholar]
  7. Griffiths D. A., Simpson R. A., Shorey B. A., Speller D. C., Williams N. B. Single-dose peroperative antibiotic prophylaxis in gastrointestinal surgery. Lancet. 1976 Aug 14;2(7981):325–328. doi: 10.1016/s0140-6736(76)92588-5. [DOI] [PubMed] [Google Scholar]
  8. Ingham H. R., Sisson P. R., Tharagonnet D., Selkon J. B., Codd A. A. Inhibition of phagocytosis in vitro by obligate anaerobes. Lancet. 1977 Dec 17;2(8051):1252–1254. doi: 10.1016/s0140-6736(77)92662-9. [DOI] [PubMed] [Google Scholar]
  9. Keighley M. R., Crapp A. R., Burdon D. W., Cooke W. T., Alexander-Williams J. Prophylaxis against anaerobic sepsis in bowel surgery. Br J Surg. 1976 Jul;63(7):538–541. doi: 10.1002/bjs.1800630711. [DOI] [PubMed] [Google Scholar]
  10. Leigh D. A. Clinical importance of infections due to Bacteroides fragilis and role of antibiotic therapy. Br Med J. 1974 Jul 27;3(5925):225–228. doi: 10.1136/bmj.3.5925.225. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Leigh D. A. Wound infections due to Bacteroides fragilis following intestinal surgery. Br J Surg. 1975 May;62(5):375–378. doi: 10.1002/bjs.1800620512. [DOI] [PubMed] [Google Scholar]
  12. Nichols R. L., Broido P., Condon R. E., Gorbach S. L., Nyhus L. M. Effect of preoperative neomycin-erythromycin intestinal preparation on the incidence of infectious complications following colon surgery. Ann Surg. 1973 Oct;178(4):453–462. doi: 10.1097/00000658-197310000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Nichols R. L., Condon R. E. Preoperative preparation of the colon. Surg Gynecol Obstet. 1971 Feb;132(2):323–337. [PubMed] [Google Scholar]
  14. Palmer D. L., Reed W. P. Delayed hypersensitivity skin testing. II. Clinical correlates and anergy. J Infect Dis. 1974 Aug;130(2):138–143. doi: 10.1093/infdis/130.2.138. [DOI] [PubMed] [Google Scholar]
  15. Ralph E. D., Kirby W. M. Unique bactericidal action of metronidazole against Bacteroides fragilis and Clostridium perfringens. Antimicrob Agents Chemother. 1975 Oct;8(4):409–414. doi: 10.1128/aac.8.4.409. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Sutter V. L., Finegold S. M. Susceptibility of anaerobic bacteria to 23 antimicrobial agents. Antimicrob Agents Chemother. 1976 Oct;10(4):736–752. doi: 10.1128/aac.10.4.736. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Tally F. P., Sutter V. L., Finegold S. M. Treatment of anaerobic infections with metronidazole. Antimicrob Agents Chemother. 1975 May;7(5):672–675. doi: 10.1128/aac.7.5.672. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Taylor S. A., Cawdery H. M. The use of metronidazole in the preparation of the bowel for surgery. Proc R Soc Med. 1977 Jul;70(7):481–482. [PMC free article] [PubMed] [Google Scholar]
  19. Washington J. A., 2nd, Dearing W. H., Judd E. S., Elveback L. R. Effect of preoperative antibiotic regimen on development of infection after intestinal surgery: Prospective, randomized, double-blind study. Ann Surg. 1974 Oct;180(4):567–572. doi: 10.1097/00000658-197410000-00021. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Whelan J. P., Hale J. H. Bactericidal activity of metronidazole against Bacteroides fragilis. J Clin Pathol. 1973 Jun;26(6):393–395. doi: 10.1136/jcp.26.6.393. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES