Colorectal surgery
Consider the principles for appropriate prescribing of surgical antibiotic prophylaxis (see Principles for appropriate prescribing of surgical antibiotic prophylaxis) and the general principles of surgical antibiotic prophylaxis for abdominal surgery. See Colorectal procedures and their requirement for surgical antibiotic prophylaxis for the recommendations for surgical prophylaxis for colorectal surgery.
If the patient is being treated with antibiotic therapy for acute intra-abdominal infection (eg diverticulitis, peritonitis), it is not necessary to give additional antibiotic prophylaxis provided the regimen has activity against the organism(s) most likely to cause postoperative infection. However, adjust the timing of the treatment dose to achieve adequate plasma and tissue concentrations at the time of surgical incision and for the duration of the procedure. See Surgical antibiotic prophylaxis for patients receiving treatment for established infection.
For a printable summary table of the indications and regimens for surgical antibiotic prophylaxis, see here.
|
Procedures |
Is surgical antibiotic prophylaxis indicated? |
|---|---|
|
endoscopic colorectal procedures |
NO |
|
nonendoscopic colorectal procedures |
YES |
For prophylaxis for nonendoscopic colorectal procedures, use:
metronidazole 500 mg (child: 12.5 mg/kg up to 500 mg) intravenously, within the 120 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed surgical prophylaxis, colorectal metronidazole
PLUS
cefazolin 2 g (child: 30 mg/kg up to 2 g) intravenously, within the 60 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, colorectal cefazolin
As an alternative, cefoxitin may be used as a single drug; however, its activity against anaerobes is inferior to the regimen above. It also requires frequent redosing (every 2 hours). Use:
cefoxitin 2 g (child: 40 mg/kg up to 2 g) intravenously, within the 60 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, colorectal cefoxitin
For patients with immediate nonsevere or delayed nonsevere hypersensitivity to penicillins, the above regimens are suitable. See also Surgical antibiotic prophylaxis for patients with a penicillin or cephalosporin allergy.
For patients with immediate severe or delayed severe hypersensitivity to penicillins, use:
metronidazole 500 mg (child: 12.5 mg/kg up to 500 mg) intravenously, within the 120 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed metronidazole
PLUS
gentamicin (adult and child) 2 mg/kg up to 180 mg intravenously over 3 to 5 minutes, within the 120 minutes before surgical incision12; intraoperative redosing is unlikely to be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, colorectal gentamicin
Oral nonabsorbable antibiotics (eg neomycin), in combination with erythromycin or metronidazole and mechanical bowel preparation, improved outcomes in elective colorectal resections in some studies.
Consider preoperative screening for faecal carriage of multidrug-resistant Gram-negative bacteria in patients with an increased likelihood of colonisation with these bacteria (see Risk factors for infection with a multidrug-resistant gram-negative bacterium). Prophylaxis for patients colonised with a multidrug-resistant Gram-negative bacterium should be guided by the results of susceptibility testing—seek expert advice.