Oral plus IV antibiotic reduces SSIs by more than 50 pc in patients undergoing colorectal surgery: JAMA

New Zealand: A recent study in the journal JAMA Surgery has demonstrated that the addition of oral antibiotics (OA) to intravenous antibiotics may reduce surgical site infections (SSI) in patients undergoing elective colorectal surgery. The results support the addition of OA to IV antibiotics in the bowel preparation for reducing incisional SSI. 

There seems to be no clarity on the best method of bowel preparation for colorectal surgery among patients undergoing elective colorectal surgery. Usually, IV antibiotics are administered but the use of mechanical bowel preparation (MBP), enemas, and/or oral antibiotics (OA) is controversial. To overcome these discrepancies, John C. Woodfield, University of Otago, Dunedin, New Zealand, and colleagues aimed to summarize all data from randomized clinical trials (RCTs) that met selection criteria using network meta-analysis (NMA) to determine the ranking of different bowel preparation treatment strategies for their associations with postoperative outcomes. 

RCTs were selected by multiple reviewers and adjudicated by a separate lead investigator. RCTs of adults undergoing elective colorectal surgery with an appropriate aerobic and anaerobic antibiotic cover that reported on incisional surgical site infection or anastomotic leak were selected for inclusion. A total of 167 of 6833 screened studies met initial selection criteria. 

Primary outcomes were incisional SSI and anastomotic leak. Secondary outcomes included other infections, mortality, ileus, and adverse effects of preparation.