Systemic Prophylaxis with Doxycycline in Surgery of the Colon and Rectum

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Abstract
A prospective double-blind study on the effects of doxycycline as a prophylactic antimicrobial in elective colonic surgery is presented. Patients (118) were evaluated. Fifty-eight were treated and 60 were controls. Doxycycline [200 .mu.g] or placebo (2 capsules) were given orally 4-6 h prior to surgery and 100 mg or placebo (1 capsule) for 5 days postoperatively. Doxycycline levels in serum and tissues were determined and related to the MIC[minimal inhibitory concentration]-values of the contaminants of the operative field. A significantly lower incidence of abdominal would sepsis, intra-abdominal complications, and septicemia was recorded in the doxycycline group compared to the control group, 12.1 and 45%, respectively. The prophylactic effect was most pronounced in patients with a negative wound culture upon closure. Macroscopical peritoneal contamination was associated with less severe consequences in the doxycycline group. Infections in the perineal field, 3/15 vs. 8/17, appeared alone in the doxycycline group, and combined with abdominal sepsis in 6/8 among the controls. Treatment also reduced the incidence of repeat laparotomy due to septic complications, 0 vs. 8. Systemic pre-and postoperative prophylaxis with doxycycline significantly reduced both the incidence and the severity of postoperative sepsis in potentially contaminated elective colorectal surgery without any adverse reactions.