Comparison of two systemic antibiotics for the prevention of complications in elective colorectal surgery

The surgical site infections are the third more frequent hospital-acquired infection and 3/4 of the deaths occurred in patients with surgical site infections are to relate to them. Antibiotic prophylax is crucial in the prevention of surgical site infections, in particular types of surgical operations such as the colon an organ with high bacterial load. The use of antibiotics, to be effective, it needs to be indicated for the type of surgical operation, pharmaceutical form, dose, timing of administration appropriate to spectrum of activity targeted to bacteria most frequently encountered. The inappropriate use of antibiotics in the prophylaxis of surgical site infection leads to the ineffectiveness of the administration with an increased incidence of infections and the cost because it increases the days of hospitalization and working days lost to sickness. It also increases the appearance iatrogenesis, the side effects of the drugs administered. The inappropriate use of antibiotics in the prophylaxis besides increments the selection of resistant strains. In a prospective randomized trial on 77 patients undergoing elective colorectal surgery, cefoxitin and cephalothin were given as systemic antibiotic prophylaxis. Cefoxitin is a betalactamase stable cephalosporin-cephamycin, especially effective against gram-negative organisms and Bacteroides species which are likely to be present in postoperative infections after large bowel surgery. These organisms were frequently shown to be resistant to the antibiotics used in systemic prophylaxis as cephalothin or ampicillin. All patients received low residue diet and preoperative standard bowel preparation with saline enema and oral laxatives for 3 days before surgery excluding the patients undergoing colo-sigmoidostomy closure operations. Two groups of 40 and 37 randomized patients were studied. Cefoxitin group: the 40 patients received cefoxitin (2 gm) intravenously 30 minutes preoperatively, an additional dose of 2 gm during surgery (over two hours) and then 2 gm 8h postpoperatively for 48 hours. Cephalothin group: the 37 patients received cephalothin (2 gm) intravenously 2 hours preoperatively, 2 gm during surgery, and 2 gm every 6 hours postoperatively for 2 days. Postoperative sepsis occurred in 2/40 (5 %) of those given cefoxitin compared to 9/37 (24.3 %) of those given cephalothin. The reduction in the infection rate in the group treated by cefoxitin was statistically significant (p<0.02). Specific drug toxicity was not evidenced except for transient skin rashes in two patients of both groups. In the patien