cefoxitin and Colonic-Diseases

A review of the literature indicates that cefoxitin is an effective single-agent therapy for community-acquired intra-abdominal infections, pelvic infections, and surgical prophylaxis. Hospital-acquired intra-abdominal infections may require the addition of an aminoglycoside.

Topics: Biliary Tract Diseases; Cefoxitin; Cesarean Section; Colonic Diseases; Endometritis; Female; Humans; Hysterectomy; Infection Control; Male; Postoperative Complications; Pregnancy; Puerperal Infection; Rectal Diseases

A prospective, randomized double-blind study was undertaken to compare the efficacy of three prophylactic regimens (oral neomycin and erythromycin, intravenous cefoxitin, and a combination of both oral and intravenous antibiotics) in patients undergoing elective colorectal surgery. One hundred sixty-nine patients were randomized and 146 patients were evaluable. Septic complications occurred in 11.4 per cent of patients receiving oral antibiotics only, in 11.7 per cent of patients receiving intravenous cefoxitin alone, and in 7.8 per cent of patients receiving both oral and intravenous antibiotics. These differences were not statistically different. The greatest number of septic complications occurred in those patients with anastomotic disruptions. Two patients died (1.3%), both of whom had major anastomotic failures. There was no advantage between any of the groups in the incidence of wound infection (3.9-6.8%). Thus, no advantage could be identified in this study in the combination of oral and intravenous antibiotics in elective colorectal surgery.

Topics: Administration, Oral; Adult; Aged; Anastomosis, Surgical; Cefoxitin; Colonic Diseases; Double-Blind Method; Drug Administration Schedule; Drug Evaluation; Drug Therapy, Combination; Erythromycin; Humans; Infusions, Intravenous; Middle Aged; Neomycin; Premedication; Prospective Studies; Randomized Controlled Trials as Topic; Rectal Diseases; Surgical Wound Infection

During a 24-month period, 350 patients were prospectively studied in an effort to determine the perioperative factors in the development of infections after colon and rectal resections. All patients received standard mechanical bowel preparation; perioperative parenteral cefoxitin (group A) or preoperative oral neomycin and erythromycin, in addition to perioperative cefoxitin (Group B), were also given. Both groups were comparable with respect to age, sex, associated diseases, and primary diagnosis. Wound infections developed in nine of 169 (5%) group B patients and in 15 of 141 (11%) group A patients. Stratification by type of operative procedure revealed that the rectal resections involved the highest rate of infection in group A (22%) and in group B (11%). In patients requiring intraperitoneal colon resection, the rates of wound sepsis were similar (3% in both groups). Analysis of length of operation revealed that in operations lasting 215 minutes or more the infection rate was 12%; in those lasting less than 215 minutes the rate was 4%. Patients with rectal resection and operative times of 215 minutes or more had a wound infection rate of 19% compared to 2% (p less than 0.05) in those with shorter nonrectal operations. Group B patients with the longer rectal operations had lower infection rates (11%) than group A patients (27%), while there was no difference among those who had shorter operations. Intra-abdominal abscesses (p less than 0.01) and anastomotic dehiscence (p less than 0.05) were also significantly reduced in group B patients. Postoperative wound infection is associated with length of operation and location of colon resection and can be significantly lowered by a combination of oral and parenteral antibiotics.

Topics: Adult; Aged; Anti-Bacterial Agents; Cefoxitin; Colonic Diseases; Colonic Neoplasms; Escherichia coli Infections; Female; Humans; Male; Middle Aged; Prospective Studies; Random Allocation; Rectal Diseases; Rectal Neoplasms; Staphylococcal Infections; Surgical Wound Infection

Antibiotic prophylaxis in elective colonic surgery is of established value and most authors have proposed an association of at least two drugs. We have compared the efficacy of classical prophylaxis (clindamycin and gentamicin, C + G) with that of the single drug cefoxitin (Ce). 101 consecutive patients were covered; 22 had to be excluded and 7 withdrawn after randomization; 72 cases were left for final analysis (C + G 35; Ce 37). Five C + G (14.2%) and 4 Ce cases (10.8%) developed septic complications, possibly caused by opening of the colon (wound infection, anastomotic failure, colocutaneous fistula): this difference is not statistically significant. Episodes of sepsis, urinary tract infection and pneumonia were similar in both groups. Although the number of patients included is relatively small, we conclude that prophylaxis with Ce alone appears to be as effective as double drug prophylaxis with C + G.

Topics: Aged; Anti-Bacterial Agents; Cefoxitin; Clindamycin; Clinical Trials as Topic; Colectomy; Colonic Diseases; Drug Therapy, Combination; Female; Gentamicins; Humans; Intestinal Fistula; Male; Middle Aged; Postoperative Complications; Preoperative Care; Prospective Studies; Random Allocation; Surgical Wound Infection

Topics: Administration, Oral; Cefoxitin; Clinical Trials as Topic; Colectomy; Colonic Diseases; Drug Administration Schedule; Humans; Injections, Intravenous; Neomycin; Nitroimidazoles; Postoperative Complications; Prospective Studies; Random Allocation; Rectal Diseases; Sepsis; Surgical Wound Infection; Tinidazole

In a prospective, randomized, comparative study, patients undergoing elective major colorectal surgery received four six-hour doses of either sulbactam (a beta-lactamase inhibitor) with ampicillin (1 gm with 1 gm), or cefoxitin (2 gm) commencing at induction of anesthesia. The groups were well matched for age, sex, diagnosis, and surgical procedures. Three patients in the sulbactam group (N = 44), and four in the cefoxitin group (N = 48) developed significant wound sepsis. Minor wound sepsis occurred in an additional four sulbactam patients, and in five cefoxitin patients. There was no difference between the groups in deep sepsis or anastomotic leak rates (sulbactam, four patients; cefoxitin, seven patients). No serious side effects were recorded in either group. These results suggest that sulbactam combined with ampicillin provides a safe, effective alternative to cefoxitin for prophylaxis in colorectal surgery.

Topics: Aged; Ampicillin; Cefoxitin; Colonic Diseases; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Injections, Intravenous; Male; Middle Aged; Penicillanic Acid; Premedication; Prospective Studies; Random Allocation; Rectal Diseases; Sulbactam; Surgical Wound Infection

The efficacy of cefoxitin or doxycycline as antibiotic prophylaxis in colorectal surgery was compared in 102 elective operations. Both drugs were used perioperatively only. Cefoxitin was used in 55 cases and doxycycline in 47. Ten patients in the cefoxitin group and 4 in doxycycline group had wound infections. Three intraabdominal abscesses were seen, one after cefoxitin and two after doxycycline prophylaxis. All three were due to anastomotic leakage. Bacteriologic studies revealed no negative ecologic effects of prophylaxis. The short-term prophylaxis used did protect against serious infectious complications. The extended spectrum of cefoxitin provided no added benefit in prophylaxis. Patients with inflammatory bowel disease treated preoperatively with salicylazosulfapyridine run a greater risk of postoperative infection in spite of the prophylaxis.

Topics: Adult; Aged; Cefoxitin; Colonic Diseases; Crohn Disease; Doxycycline; Female; Humans; Male; Middle Aged; Postoperative Complications; Prospective Studies; Random Allocation; Rectal Diseases; Sulfasalazine; Surgical Wound Infection

Toward the completion of elective colorectal operations, 75 patients had qualitative aerobic and anaerobic cultures of specimens obtained from peritoneal irrigation fluid, anastomoses sites, and abdominal wound irrigation fluid to determine if a correlation exists between intraoperative flora and postoperative infectious complications. Patients enrolled in this prospective study received a mechanical bowel prep and a 12-18 hour course of perioperative intravenous antibiotics. Comparisons were made between the 60 (80%) patients who had no postoperative infections and the 15 (20%) who developed postoperative infectious complications (9 wound infections, 6 intraabdominal infections). There were significantly more low anterior resections in patients who developed postoperative infection compared to those who had no postoperative infection (26% vs 2%), while there were more colocolostomies in the group with no infections (38% vs 7%). Streptococcus spp., Bacteroides fragilis group, and Escherichia coli were the most commonly isolated organisms from each of the three sites sampled. Isolation of > or = 3 organisms from incisional wound cultures (P = 0.017) and < or = 4 organisms from peritoneal irrigation (P = 0.009) or anastomotic culture (P = 0.004) correlated with development of postoperative infectious complications. Thus, patients with infectious complications had significantly more isolates than those without infectious complications, and were more likely to have had a low anterior resection. These data suggest that future clinical studies should reexamine the duration of perioperative antimicrobials based on early laboratory reports of qualitative and quantitative operative site bacteriology.

Topics: Abdomen; Adolescent; Adult; Aged; Anti-Bacterial Agents; Bacteria, Aerobic; Bacteria, Anaerobic; Bacterial Infections; Cefotetan; Cefoxitin; Colonic Diseases; Digestive System; Elective Surgical Procedures; Female; Humans; Male; Middle Aged; Premedication; Prospective Studies; Rectal Diseases; Surgical Wound Infection

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Cefotetan; Cefoxitin; Colonic Diseases; Controlled Clinical Trials as Topic; Digestive System Surgical Procedures; Elective Surgical Procedures; Humans; Rectal Diseases; Surgical Wound Infection

Colostomy closure has also today a complication rate between 20 and 30% in the literature, in which infectious complications are playing a substantial role. Increasing experience and standardization as well as better preoperative treatment, like whole gut irrigation and perioperative antibiotics and the additional use of a Gentamicin-PMMA-chain, led to a distinct reduction of the postoperative complication rate in a prospective study of 40 colostomy closures.

Topics: Adult; Aged; Aged, 80 and over; Cefoxitin; Colon; Colonic Diseases; Colostomy; Drug Therapy, Combination; Female; Gentamicins; Humans; Male; Methylmethacrylates; Middle Aged; Postoperative Complications; Premedication; Preoperative Care; Rectum; Surgical Wound Infection; Therapeutic Irrigation

Topics: Adolescent; Adult; Aged; Cefoxitin; Colectomy; Colonic Diseases; Costs and Cost Analysis; Female; Humans; Length of Stay; Male; Middle Aged; Postoperative Period; Suture Techniques