SYSTEMIC PROPHYLAXIS WITH METRONIDAZOLE (FLAGYL) IN ELECTIVE SURGERY OF THE COLON AND RECTUM

  • 1 January 1980
    • journal article
    • research article
    • Vol. 87  (5) , 560-566
Abstract
The effect of metronidazole prophylaxis in elective colonic and rectal surgery was studied in a prospective double-blind trial in which metronidazole was compared with a placebo. Fifty-six patients were included in the study and the patients were randomly allocated to the 2 groups. Twenty-five patients received 2 g of metronidazole the day before operation and 1.2 g as a single daily dose for 5 days after operation. Twenty-one patients were given placebos in the same dosage. Before operation all patients were prepared with mechanical evacuation of the bowel. A significantly lower frequency of wound sepsis, intraabdominal complications and septicemia was found in the metronidazole group as compared to the placebo group. The incidence was 4.0 and 36%, respectively. Following protectomy, infection in the perineal area occurred in 33 and 43% of the respective groups. In the metronidazole-treated patients this was the only complication, whereas 50% of the patients in the placebo group developed intraabdominal complications. After operation anaerobic bacteria were isolated from 8% of the patients who received prophylactic metronidazole. In the control group 67% of the patients had a positive postoperative anaerobic culture. Bacteroides fragilis was isolated from 13 of 14 patients with postoperative infection in the placebo group. B. fragilis was not isolated from any of the metronidazole-treated patients. Anaerobic bacteria are apparently the major contributors to wound infection following colonic and rectal surgery and metronidazole prophylaxis greatly reduces the frequency of postoperative infection.