povidone-iodine and Diverticulum--Colon

The anti-infective actions of povidone-iodine (PVI) and sodium hypochlorite enemas are different.. Prospective, randomized, single-blind study.. Multicenter.. Five hundred seventeen consecutive patients with colorectal carcinoma or sigmoid diverticular disease undergoing elective open colorectal resection, followed by primary anastomosis.. All patients received senna (1-2 packages diluted in a glass of water) at 6 pm the evening before surgery. Patients were administered two 2-L aqueous enemas of 5% PVI (n = 277) or 0.3% sodium hypochlorite (n = 240) at 9 pm the evening before surgery and at 3 hours before operation. Intravenous ceftriaxone sodium (1 g) and metronidazole (1 g) were administered at anesthetic induction.. Rate of patients with 1 infective parietoabdominal complication or more.. The percentages of patients with 1 infective parietoabdominal complication or more did not differ between the 2 groups (13.7% in the PVI-treated group vs 15.0% in the sodium hypochlorite-treated group). Tolerance was better in the PVI-treated group than in the sodium hypochlorite-treated group (79.4% vs 67.9%), with fewer patients experiencing abdominal pain (13.0% vs 24.6%) or discontinuing their preparation (3.0% vs 9.0%) (P=.02 for all). There were more patients with malaise in the PVI-treated group than in the sodium hypochlorite-treated group (9.1% vs 4.9%, P<.05). Three patients in the sodium hypochlorite-treated group had necrotic ulcerative colitis.. When antiseptic enemas are chosen for mechanical preparation before colorectal surgery, PVI should be preferred over sodium hypochlorite because of better tolerance and avoidance of necrotic ulcerative colitis.

Topics: Adult; Aged; Aged, 80 and over; Anastomosis, Surgical; Anti-Infective Agents, Local; Colon; Colorectal Neoplasms; Disinfectants; Diverticulum, Colon; Elective Surgical Procedures; Enema; Female; Humans; Male; Middle Aged; Povidone-Iodine; Preoperative Care; Prospective Studies; Rectum; Sigmoid Diseases; Single-Blind Method; Sodium Hypochlorite

Patients undergoing elective left colectomy for colonic carcinoma or diverticulosis (n = 341) were randomly assigned to three groups. Patients in groups 1 (102 patients) and 2 (122 patients) had two 5% povidone-iodine enemas whereas those in group 3 (117 patients) had saline enemas. Groups 1 and 3 received 24-hour intravenous cefotaxime sodium and metronidazole hydrochloride. Group 2 received single injections of ceftriaxone sodium (1 g) and ornidazole (1 g). Senna concentrate was administered the evening before surgery. There was no statistically significant difference found between groups 1 and 2 concerning the number of infected patients (eight vs 11), anastomotic leakages (four vs four), extra-abdominal complications (32 vs 29), or infection-related deaths (one vs zero). Despite poorer tolerance, povidone-iodine enema was more effective than saline enemas, as there were less infected patients in group 1 (8%) or groups 1 + 2 (8.5%) than in group 3 (13%). Single-dose ceftriaxone-ornidazole combined with povidone-iodine enemas is effective against infective complications in elective left colonic surgery for carcinoma or diverticular disease. Single-dose antibiotic prophylaxis reduces costs and work for the nursing staff.

Topics: Adult; Aged; Aged, 80 and over; Anastomosis, Surgical; Cefotaxime; Ceftriaxone; Colectomy; Colonic Neoplasms; Diverticulum, Colon; Drug Tolerance; Enema; Female; Humans; Male; Metronidazole; Middle Aged; Ornidazole; Povidone-Iodine; Prognosis; Risk Factors; Senna Extract; Surgical Wound Infection; Survival Rate