A patient with a non obstructing carcinoma of the sigmoid colon is being prepared for elective resection. To minimize the risk of postoperative infectious complications, your planning should include
Many clinical and experimental studies have looked at the optimum bowel preparation and preoperative regimen for elective colonic surgery to reduce the postoperative infectious complications of wound infection, intra-abdominal abscess, and anastomotic leakage. Currently a postoperative rate of wound infection of only 5% can be attained by combining mechanical cleansing, oral antibiotics, and perioperative parenteral antibiotics. Oral antibiotics may be administered one hour prior to surgery and should cover all anaerobes (e.g., neomycin-erythromycin), antibiotics effective against aerobes (e.g., cefoxitin) should be administered in the operating room as a single dose and not postoperatively. Both antibiotic regimens are for prophylaxis without fostering resistant against microbes.
A single preoperative parenteral dose of antibiotic effective against aerobes and anaerobes.
Avoidance of oral antibiotics to prevent emergence of clostridium difficile
Postoperative administration for 2 to 4 days of parenteral antibiotics effective against aerobes and anaerobes
Postoperative administration for 5 to 7 days of parenteral antibiotics effective against aerobes and anaerobes