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Meta-Analysis
. 2014 May 9;2014(5):CD001181.
doi: 10.1002/14651858.CD001181.pub4.

Antimicrobial prophylaxis for colorectal surgery

Richard L Nelson  1 , Ed Gladman, Marija Barbateskovic
Affiliations
Meta-Analysis

Antimicrobial prophylaxis for colorectal surgery

Richard L Nelson et al. Cochrane Database Syst Rev. .

Abstract

Background: Research shows that administration of prophylactic antibiotics before colorectal surgery prevents postoperative surgical wound infection. The best antibiotic choice, timing of administration and route of administration remain undetermined.

Objectives: To establish the effectiveness of antimicrobial prophylaxis for the prevention of surgical wound infection in patients undergoing colorectal surgery. Specifically to determine:1. whether antimicrobial prophylaxis reduces the risk of surgical wound infection;2. the target spectrum of bacteria (aerobic or anaerobic bacteria, or both);3. the best timing and duration of antibiotic administration;4. the most effective route of antibiotic administration (intravenous, oral or both);5. whether any antibiotic is clearly more effective than the currently recommended gold standard specified in published guidelines;6. whether antibiotics should be given before or after surgery.

Search methods: For the original review published in 2009 we searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE (Ovid) and EMBASE (Ovid). For the update of this review we rewrote the search strategies and extended the search to cover from 1954 for MEDLINE and 1974 for EMBASE up to 7 January 2013. We searched CENTRAL on the same date (Issue 12, 2012).

Selection criteria: Randomised controlled trials of prophylactic antibiotic use in elective and emergency colorectal surgery, with surgical wound infection as an outcome.

Data collection and analysis: Data were abstracted and reviewed by one review author and checked by another only for the single, dichotomous outcome of surgical wound infection. Quality of evidence was assessed using GRADE methods.

Main results: This updated review includes 260 trials and 68 different antibiotics, including 24 cephalosporins and 43,451 participants. Many studies had multiple variables that separated the two study groups; these could not be compared to other studies that tested one antibiotic and had a single variable separating the two groups. We did not consider the risk of bias arising from attrition and lack of blinding of outcome assessors to affect the results for surgical wound infection.Meta-analyses demonstrated a statistically significant difference in postoperative surgical wound infection when prophylactic antibiotics were compared to placebo/no treatment (risk ratio (RR) 0.34, 95% confidence interval (CI) 0.28 to 0.41, high quality evidence). This translates to a reduction in risk from 39% to 13% with prophylactic antibiotics. The slightly higher risk of wound infection with short-term compared with long-term duration antibiotic did not reach statistical significance (RR 1.10, 95% CI 0.93 to 1.30). Similarly risk of would infection was slightly higher with single-dose antibiotics when compared with multiple dose antibiotics, but the results are compatible with benefit and harm (RR 1.30, 95% CI 0.81 to 2.10). Additional aerobic coverage and additional anaerobic coverage both showed statistically significant improvements in surgical wound infection rates (RR 0.44, 95% CI 0.29 to 0.68 and RR 0.47, 95% CI 0.31 to 0.71, respectively), as did combined oral and intravenous antibiotic prophylaxis when compared to intravenous alone (RR 0.56, 95% CI 0.43 to 0.74), or oral alone (RR 0.56, 95% CI 0.40 to 0.76). Comparison of an antibiotic with anaerobic specificity to one with aerobic specificity showed no significant advantage for either one (RR 0.84, 95% CI 0.30 to 2.36). Two small studies compared giving antibiotics before or after surgery and no significant difference in this timing was found (RR 0.67, 95% CI 0.21 to 2.15). Established gold-standard regimens recommended in major guidelines were no less effective than any other antibiotic choice.

Authors' conclusions: This review has found high quality evidence that antibiotics covering aerobic and anaerobic bacteria delivered orally or intravenously (or both) prior to elective colorectal surgery reduce the risk of surgical wound infection. Our review shows that antibiotics delivered within this framework can reduce the risk of postoperative surgical wound infection by as much as 75%. It is not known whether oral antibiotics would still have these effects when the colon is not empty. This aspect of antibiotic dosing has not been tested. Further research is required to establish the optimal timing and duration of dosing, and the frequency of longer-term adverse effects such as Clostridium difficile pseudomembranous colitis.

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Conflict of interest statement

None known.

Figures

1
1
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 Antibiotic versus no antibiotic/placebo, Outcome 1 Surgical wound infection (SWI).
2.1
2.1. Analysis
Comparison 2 Duration of therapy, Outcome 1 Surgical wound infection (SWI).
2.2
2.2. Analysis
Comparison 2 Duration of therapy, Outcome 2 Surgical wound infection (SWI).
3.1
3.1. Analysis
Comparison 3 Additional aerobic coverage, Outcome 1 Surgical wound infection (SWI).
4.1
4.1. Analysis
Comparison 4 Additional anaerobic coverage, Outcome 1 Surgical wound infection (SWI).
5.1
5.1. Analysis
Comparison 5 Aerobic versus anaerobic cover, Outcome 1 Surgical wound infection.
6.1
6.1. Analysis
Comparison 6 Oral versus intravenous, Outcome 1 Surgical wound infection (SWI).
7.1
7.1. Analysis
Comparison 7 Combined oral and intravenous versus oral or intravenous alone, Outcome 1 Surgical wound infection: oral + iv versus iv alone.
7.2
7.2. Analysis
Comparison 7 Combined oral and intravenous versus oral or intravenous alone, Outcome 2 Surgical wound infection: combined oral and iv versus oral alone.
8.1
8.1. Analysis
Comparison 8 Antibiotic given pre‐ or postoperatively, Outcome 1 Surgical wound infection.
9.1
9.1. Analysis
Comparison 9 Antibiotic choice versus a gold standard, Outcome 1 Surgical wound infection (SWI).
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Aberg 1984 {published data only}
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Burdon 1987 {published data only}
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Cann 1988 {published data only}
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Carr 1984 {published data only}
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Claesson 1986 {published data only}
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Clarke 1977 {published data only}
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Coppa 1983 {published data only}
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Cuthbertson 1983 {published data only}
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Cuthbertson 1991 {published data only}
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Diamond 1988 {published data only}
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Dion 1980 {published data only}
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Edmondson 1983 {published data only}
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Figueras‐Felip 1984 {published data only}
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Hagen 1980 {published data only}
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Hakansson 1993 {published data only}
    1. Hakansson T, Raahave D, Hansen OH, Pedersen T. Effectiveness of single dose prophylaxis with cefotaxime and metronidazole compared with three doses of cefotaxime alone in elective colorectal surgery. European Journal of Surgery 1993;159:177‐80. - PubMed
Hall 1989a {published data only}
    1. Hall JC, Watts JM, O'Brien P, Turnbridge J, McDonald P. Single‐dose antibiotic prophylaxis in contaminated abdominal surgery. Archives of Surgery 1989;124:224‐7. - PubMed
Hall 1989b {published data only}
    1. Hall C, Curran F, Burdon DW, Keighley MRB. A randomized trial to compare amoxycillin/clavulanate with metronidazole plus gentamicin in prophylaxis in elective colorectal surgery. Journal of Antimicrobial Chemotherapy 1989;24(Suppl B):195‐202. - PubMed
Hall 1991 {published data only}
    1. Hall JC, Hall JL, Christiansen K. A comparison of the roles of cefamandole and ceftriaxone in abdominal surgery. Archives of Surgery 1991;126:512‐6. - PubMed
Hancke 1986 {published data only}
    1. Hancke E, Marklein G, Jensen JC, Voigt U, Stute H, Berker‐von‐Schlichting C. Antimicrobial chemoprevention in colorectal interventions: a single parenteral dose at the start of surgery is adequate. Chirurgie 1986;57(6):406‐10. - PubMed
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Hansell 1983 {published data only}
    1. Hansell DT, Thomson GJ, Simpson CJ, Morran C, Smith DC, McNaught W, et al. Metronidazole prophylaxis in colorectal surgery: the need for additional aminoglycoside?. Journal of Hospital Infection 1983;4(4):383‐90. - PubMed
Haverkorn 1985 {published data only}
    1. Haverkorn MJ. Peroperative systematic prophylaxis in colorectal surgery. Drugs Under Experimental and Clinical Research 1985;11(2):111‐4. - PubMed
Hershman 1987 {published data only}
    1. Hershman M, Reilly D, Sackier J, Gompertz H, Swift R, Wood C. A prospective comparative study of cefotetan with piperacillin for prophylaxis against infection in elective colorectal surgery. Chemioterapia 1987;6(2 Suppl):600. - PubMed
Hershman 1990 {published data only}
    1. Hershman MJ, Swift RI, Reilly DT, Logan WA, Sackier JM, Gompertz H, et al. Prospective comparative study of cefotetan with piperacillin for prophylaxis against infection in elective colorectal surgery. Journal of the Royal College of Surgeons of Edinburgh 1990;35(1):29‐32. - PubMed
Hinchey 1983 {published data only}
    1. Hinchey EJ, Richards GK, Prentis J. Metronidazole as a prophylactic agent in wound infection after colon surgery. Surgery 1983;93:197‐200. - PubMed
Hinchey 1987 {published data only}
    1. Hinchey EJ, Richards GK, Lewis R, Echave V, Biron JS, Weissglass I. Moxalactam as single‐agent prophylaxis in the prevention of wound infection following colon surgery. Surgery 1987;101(1):15‐9. - PubMed
Hobbiss 1988 {published data only}
    1. Hobbiss JH, Carr ND, Schofield PF. Are we using the correct dose of metronidazole in colorectal surgery?. Journal of the Royal Society of Medicine 1988;81(2):95‐6. - PMC - PubMed
Hoffmann 1981 {published data only}
    1. Hoffman CEJ, McDonald PJ, Watts J. Use of peroperative cefoxitin to prevent infection after colonic and rectal surgery. Annals of Surgery 1981;193(3):353‐6. - PMC - PubMed
Höjer 1978 {published data only}
    1. Höjer H. The effect on total antimicrobial consumption and hospitalization time after prophylactic treatment with doxycycline in colorectal surgery. Acta Chirurgica Scandinavica 1978;144(3):175‐9. - PubMed
Höjer 1980 {published data only}
    1. Hoejer H, Wetterfors J. On the effect on antimicrobial use and postoperative hospital stay of prophylactic treatment with doxycycline in colorectal surgery. Scandinavian Journal of Gastroenterology 1980;Suppl 59:5‐9. - PubMed
Hosie 1992 {published data only}
    1. Hosie KB, Fielding JWL, Alexander‐Williams J, Temple JG, Keighley MRB. Ceftizoxime alone or in combination with metronidazole as prophylaxis in elective colorectal surgery. Drug Investigation 1992;4(1):13‐6.
Hughes 1979 {published data only}
    1. Hughes ESR, McDermott FT, White A, Masterton JP. Cephaloridine prophylaxis in resection of the large intestine. Australian and New Zealand Journal of Surgery 1979;49(4):434‐7. - PubMed
Hunt 1979 {published data only}
    1. Hunt PS, Francis JK, Peck G, Farrell K, Sali A. Tinidazole in the prevention of wound infection after elective colorectal surgery. Medical Journal of Australia 1979;1(4):107‐9. - PubMed
Ishida 2001 {published data only}
    1. Ishida H, Yokoyama M, Nakada H, Inokuma S, Hashimoto D. Impact of oral antimicrobial prophylaxis on surgical site infection and methicillin‐resistant Staphylococcus aureus infection after elective colorectal surgery. Results of a prospective randomized trial. Surgery Today 2001;31(11):979‐83. - PubMed
Itani 2006 {published data only}
    1. Itani KMF, Wilson SE, Awad SS, Jensen EH, Finn TS, Abramson MA. Ertapenem versus cefotetan prophylaxis in elective colorectal surgery. New England Journal of Medicine 2006;355:2640‐51. - PubMed
Ivarsson 1982 {published data only}
    1. Ivarsson L, Darle N, Kewenter JG, Seeberg S, Norrby R. Short‐term systemic prophylaxis with cefoxitin and doxycycline in colorectal surgery. A prospective, randomized study. American Journal of Surgery 1982;144(2):257‐61. - PubMed
Jagelman 1982 {published data only}
    1. Jagelman DG, Fazio VW, Lavery IC, Weakley FL, Chaney TL. A prospective randomized study of prophylactic mannitol (10%)‐neomycin‐cefotaxime therapy in patients undergoing elective colonic and rectal surgery. Clinical Therapeutics: 1982;5 Suppl A:32‐7. - PubMed
Jagelman 1985 {published data only}
    1. Jagelman DG, Fazio VW, Lavery IC, Weakley FL. A prospective, randomised, double‐blind study of 10% mannitol mechanical bowel preparation combined with oral neomycin and short‐term, perioperative, intravenous Flagyl as prophylaxis in elective colorectal resections. Surgery 1985;98(5):861‐5. - PubMed
Jagelman 1987 {published data only}
    1. Jagelman DG, Fazio VW, Lavery IC, Weakley FL, Tusek D. Single‐dose piperacillin versus cefoxitin combined with 10 percent mannitol bowel preparation as prophylaxis in elective colorectal operations. American Journal of Surgery 1987;154(5):478‐81. - PubMed
Jagelman 1988 {published data only}
    1. Jagelman DJ, Fabian TC, Nichols RL, Stone HH, Wilson SE, Zellner SR. Single‐dose cefotetan versus multiple‐dose cefoxitin as prophylaxis in colorectal surgery. American Journal of Surgery 1988;155(5A):71‐6. - PubMed
Jensen 1990 {published data only}
    1. Jensen LS, Anderson A, Fristrup SC, Holme JB, Hvid HM, Kraglund K, et al. Comparison of one dose versus three doses of prophylactic antibiotics and the influence of blood transfusion, on infectious complications in acute and elective colorectal surgery. British Journal of Surgery 1990;77(5):513‐8. - PubMed
Jones 1987 {published data only}
    1. Jones RN, Wojeski W, Bakke J, Porter C, Searles M. Antibiotic prophylaxis of 1,036 patients undergoing elective surgical procedures: a prospective randomized comparative trial of cefazolin, cefoxitin and cefotaxime in a prepaid medical practice. American Journal of Surgery 1987;153:341‐6. - PubMed
Jones 1987b {published data only}
    1. Jones RN, Wojeski WV. Single‐dose surgical prophylaxis using ticarcillin/clavulanic acid (Timentin): a prospective, randomized comparison with cefotaxime. Diagnostic Microbiology and Infectious Disease 1987;7:219‐23. - PubMed
Jones 1987c {published data only}
    1. Jones RN, Slepack JM, Wojeski WV. Cefotaxime single‐dose surgical prophylaxis in a pre‐paid group practice. Comparisons with other cephalosporins and ticarcillin/clavulanic acid. Drugs 1988;35(Suppl 2):116‐23. - PubMed
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Jostarndt 1980 {published data only}
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Juul 1987 {published data only}
    1. Juul P, Klaaborg KE. Single or multiple doses of metronidazole and ampicillin in elective colorectal surgery: a randomised trial. Diseases of the Colon and Rectum 1987;30(7):526‐8. - PubMed
Kaiser 1983 {published data only}
    1. Kaiser AB, Herrington JL Jr, Jacobs JK, Mulherin JL Jr, Roach AC, Sawyers JL. Cefoxitin versus erythromycin, neomycin, and cefazolin in colorectal operations. Importance of the duration of the surgical procedure. Annals of Surgery 1983;198(4):525‐30. - PMC - PubMed
Karran 1993 {published data only}
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Keighley 1976 {published data only}
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Keighley 1979 {published data only}
    1. Keighley MR, Arabi Y, Alexander‐Williams J, Youngs D, Burdon DW. Comparison between systemic and oral antimicrobial prophylaxis in colorectal surgery. Lancet 1979;1(8122):894‐7. - PubMed
Keighley 1983 {published data only}
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Khubchandani 1989 {published data only}
    1. Khubchandani IT, Karamchandani MC, Sheets JA, Stasik JJ, Rosen L, Riether RD. Metronidazole vs. erythromycin, neomycin and cefazolin in prophylaxis for colonic surgery. Diseases of the Colon and Rectum 1989;32(1):17‐20. - PubMed
Kingston 1989 {published data only}
    1. Kingston RD, Kiff RS, Duthie JS, Walsh S, Spicer A, Jeacock J. Comparison of two prophylactic single‐dose intravenous antibiotic regimes in the treatment of patients undergoing elective colorectal surgery in a district general hospital. Journal of the Royal College of Surgeons of Edinburgh 1989;34:208‐11. - PubMed
Kläy 1983 {published data only}
    1. Kläy K, Hassler H, Aeberhard P. Perioperative antibiotic prophylaxis in colon surgery. Metronidazole and tobramycin versus metronidazole alone. A prospective randomized study. Schweizerische Medizinische Wochenschrift 1983;113(11):392‐4. - PubMed
Kling 1985 {published data only}
    1. Kling PA, Homlund D, Burman L. Single‐dose intravenous metronidazole v. doxycycline prophylaxis in colorectal surgery. An open prospective, randomized trial. Acta Chirurgica Scandinavica 1985;151:163‐8. - PubMed
Kling 1988 {published data only}
    1. Kling PA, Burman LG. Failure of single‐dose metronidazole prophylaxis in colorectal surgery. No benefit from high dosage or combination with nalidixic acid. Acta Chirurgica Scandinavica 1988;154:305‐9. - PubMed
Kling 1989 {published data only}
    1. Kling PA, Dahlgren S. Oral prophylaxis with neomycin and erythromycin in colorectal surgery. More proof for efficacy than failure. Archives of Surgery 1989;124:705‐7. - PubMed
Kobayashi 2007 {published data only}
    1. Kobayashi M, Mohri Y, Tonouchi H, Miki C, Nakai K, Kusunoki M, et al. Randomized clinical trial comparing intravenous antimicrobial prophylaxis alone with oral and intravenous antimicrobial prophylaxis for the prevention of a surgical site infection in colorectal cancer surgery. Surgery Today 2007;37(5):383‐8. - PubMed
Kow 1995 {published data only}
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Kow 1995a {published data only}
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Kwok 1993 {published data only}
    1. Kwok SP, Lau WY, Leung KL, Ku KW, Ho WS, Li AK. Amoxycillin and clavulanic acid versus cefotaxime and metronidazole as antibiotic prophylaxis in elective colorectal resectional surgery. Chemotherapy 1993;39:135‐9. - PubMed
Lafaix 1983 {published data only}
    1. Lafaix C, Langlois O. Comparative study of tinidazole and ornidazole for the prevention of septic complications of colonic surgery [French] [Etude comparative tinidazole‐ornidazole pour la prophylaxie des complications septiques de la chirurgie colique]. Pathologie Biologie 1983;31(6):509‐11. - PubMed
Laitinen 1984a {published data only}
    1. Laitinen S, Stahlberg M, Kairaluoma MI. Tinidazole prophylaxis in elective colorectal surgery. Scandinavian Journal of Gastroenterology 1984;19(8):1027‐30. - PubMed
Lau 1988 {published data only}
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Lauridsen 1988 {published data only}
    1. Lauridsen F, Bjoernsen K, Nielsen SAD, Hansen OH. Short‐term prophylaxis with cefotaxime in colorectal surgery: a prospective, randomized trial. Diseases of the Colon and Rectum 1988;31(1):25‐7. - PubMed
Lazorthes 1982 {published data only}
    1. Lazorthes F, Legrand G, Monrozies X, Fretigny E, Pugnet G, Cordova JA, et al. Comparison between oral and systemic antibiotics and their combined use for the prevention of complications in colorectal surgery. Diseases of the Colon and Rectum 1982;25(4):309‐11. - PubMed
Leandoer 1976 {published data only}
    1. Leandoer L, Ekelund G, Genell S, Olson S. Antibiotic prophylaxis in colorectal surgery. Deoxycycline compared to a combination of benzylpenicillin and streptomycin. A preliminary report. Scandinavian Journal of Infectious Diseases. Supplementum 1976;9:106‐8. - PubMed
Lewis 1978 {published data only}
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Lewis 1981 {published data only}
    1. Lewis RT, Allan CM, Goodall RG, Lloyd‐Smith WC, Marien B, Park M, et al. Preventing anaerobic infection in surgery of the colon. Canadian Journal of Surgery. Journal Canadien de Chirurgie 1981;24(2):139‐41. - PubMed
Lewis 1983 {published data only}
    1. Lewis RT, Allan CM, Goodall RG, Marien B, Park M, Lloyd‐Smith W, et al. Are first‐generation cephalosporins effective for antibiotic prophylaxis in elective surgery of the colon?. Canadian Journal of Surgery. Journal Canadien de Chirurgie 1983;26(6):504‐7. - PubMed
Lewis 1989 {published data only}
    1. Lewis RT, Goodall RG, Marien B, Lloyd‐Smith W, Park M, Wiegand FM. Is neomycin necessary for bowel preparation in surgery of the colon? Oral neomycin plus erythromycin versus erythromycin‐metronidazole. Canadian Journal of Surgery. Journal Canadien de Chirurgie 1989;32(4):265‐70. - PubMed
Lewis 2002 {published data only}
    1. Lewis RT. Oral versus systemic antibiotic prophylaxis in elective colon surgery: a randomized study and meta‐analysis send a message from the 1990s. Canadian Journal of Surgery. Journal Canadien de Chirurgie 2002;45(3):173‐80. - PMC - PubMed
Lindhagen 1984 {published data only}
    1. Lindhagen J, Andaker L, Hojer H. Comparison of systematic prophylaxis with metronidazole/placebo and metronidazole/fosfomycin in colorectal surgery. Acta Chirurgica Scandinavica 1984;150:317‐23. - PubMed
Lohde 1992 {published data only}
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Lohr 1984 {published data only}
    1. Lohr J, Wagner PK, Rothmund M. Peri‐operative antibiotic prophylaxis (single of multiple dose) in elective colorectal surgery [Perioperative antibioticaprophylaxe (Einmal‐oder Mehrfachgabe) bei elektiven colorectalen eingriffen]. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen 1984;55:512‐4. - PubMed
Lozano 1985 {published data only}
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Luke 1991 {published data only}
    1. Luke M, Iversen J, Sondergaard J, Kvist E, Lund P, Andersen F, et al. Ceftriaxone versus ampicillin and metronidazole as prophylaxis against infections after clean‐contaminated abdominal surgery. European Journal of Surgery 1991;157:45‐9. - PubMed
Lumley 1992 {published data only}
    1. Lumley JW, Siu SK, Pillay SP, Stitz R, Kemp RJ, Faoagali J, et al. Single dose ceftriaxone as prophylaxis for sepsis in colorectal surgery. Australian and New Zealand Journal of Surgery 1992;62:292‐6. - PubMed
Lykkegaard 1978 {published data only}
    1. Lykkegaard Nielsen M, Scheibel JH, Wamberg T. Septic complications in colo‐rectal surgery after 24 hours versus 60 hours of preoperative antibiotic bowel preparation. I. Prospective, randomized, double‐blind clinical study. Acta Chirurgica Scandinavica 1978;144(7‐8):523‐6. - PubMed
Maki 1982 {published data only}
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Marti 1982 {published data only}
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Matheson 1978 {published data only}
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Matikainen 1993 {published data only}
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McArdle 1995 {published data only}
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McArdle 1995 A {published data only}
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McCulloch 1986 {published data only}
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McDermott 1981 {published data only}
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McDonald 1983 {published data only}
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McEntee 1989 {published data only}
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McLeish 1987 {published data only}
    1. McLeish AR, Waxman B, Ross H, Allsop JR, Andrew JH, Bennett RC, et al. Systemic Timentin is superior to oral tinidazole for antibiotic prophylaxis in elective colorectal surgery. Diseases of the Colon and Rectum 1987;30(10):786‐9. - PubMed
Mehigan 1981 {published data only}
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Mendel 1985 {published data only}
    1. Mendel V. One‐shot prophylaxis with latamoxef in elective colorectal surgery [Einmalprophylaxe mit latamoxef in der elektiven kolonchirurgie]. Medizinische Klinik 1985;80(18):495‐7.
Mendel 1987 {published data only}
    1. Mendel V, Jung D, Heymann H. Single‐shot antibiotic prophylaxis in colon surgery. Chemioterapia 1987;6:597‐600. - PubMed
Mendes 1977 {published data only}
    1. Mendes da Costa P, Klastersky J, Gerard A. Controlled study of oral administration of antibiotics in the preparation of digestive surgery (author's transl) [French] [Etude controlee de l'administration orale d'antibiotiques comme preparation a la chirurgie digestive]. Acta Chirurgica Belgica 1977;76(5):475‐80. - PubMed
Menzel 1993 {published data only}
    1. Menzel J, Bauer J, Pritzbuer E, Klempa I. Perioperative use of ampicillin/sulbactam, cefoxitin and piperacillin/metronidazole in elective colon and rectal surgery. A prospective randomized quality assurance study of 422 patients [Perioperative anwendung von ampicillin/sulbacatm, cefoxitin und piperacillin/metronidazol in der elektiven colon‐und rectumchirurgie [German]]. Der Chirurg 1993;64:649‐52. - PubMed
Menzel 1993 A {published data only}
    1. Menzel J, Bauer J, Pritzbuer E, Klempa I. Perioperative use of ampicillin/sulbactam, cefoxitin and piperacillin/metronidazole in elective colon and rectal surgery. A prospective randomized quality assurance study of 422 patients [Perioperative anwendung von ampicillin/sulbacatm, cefoxitin und piperacillin/metronidazol in der elektiven colon‐und rectumchirurgie [German]]. Der Chirurg 1993;64:649‐52. - PubMed
Menzies 1989 {published data only}
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Mitchell 1983 {published data only}
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Mittermayer 1984 {published data only}
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Moen 1980 {published data only}
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Moesgaard 1989 {published data only}
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Monrozies 1983 {published data only}
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Morris 1983 {published data only}
    1. Morris DL, Hares MM, Voogt RJ, Burdon DW, Keighley MR. Metronidazole need not be combined with an aminoglycoside when used for prophylaxis in elective colorectal surgery. Journal of Hospital Infection 1983;4(1):65‐9. - PubMed
Morris 1984 {published data only}
    1. Morris DL, Fabricius PJ, Ambrose NS, Scammell B, Burdon DW, Keighley MRB. A high incidence of bleeding is observed in a trial to determine whether addition of metronidazole is needed with latamoxef for prophylaxis in colorectal surgery. Journal of Hospital Infection 1984;5:398‐408. - PubMed
Morris 1990 {published data only}
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Morris 1993 {published data only}
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Mosimann 1987 {published data only}
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Mosimann 1997 {published data only}
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Nel 1989 {published data only}
    1. Nel CJC. Ceftriaxone as prophylaxis for elective abdominal and colorectal surgery. South African Journal of Surgery 1989;Suppl:6. - PubMed
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    1. Nichols RL, Broido P, Condon RE, Gorbach SL, Nyhus LM. Effect of preoperative neomycin‐erythromycin intestinal preparation on the incidence of infectious complications following colon surgery. Annals of Surgery 1973;178:453‐9. - PMC - PubMed
Nohr 1990 {published data only}
    1. Nohr M, Andersen JC, Juul‐Jensen KE. Prophylactic single‐dose fosfomycin and metronidazole compared with neomycin, bacitracin, metronidazole and ampicillin in elective colorectal operations. Acta Chirurgica Scandinavica 1990;156:223‐30. - PubMed
Norwegian Study 1985 {published data only}
    1. The Norwegian Study Group for Colorectal Surgery. Should antimicrobial prophylaxis in colorectal surgery include agents effective against both anaerobic and aerobic microorganisms? A double‐blind, multicenter study. Surgery 1985;97(4):402‐7. - PubMed
Nyam 1995 {published data only}
    1. Nyam DCNK, Yeo M, Cheong D, Goth HS. Antibiotic prophylaxis in colorectal surgery: a randomised, double‐blind, controlled trial of amoxycillin‐clavulanic acid versus ceftriaxone and metronidazole. Asian Journal of Surgery 1995;18(3):227‐30.
Nygaard 1980 {published data only}
    1. Nygaard K, Hognestad J. Infection prophylaxis with doxycycline in colorectal surgery. A preliminary report. Scandinavian Journal of Gastroenterology. Supplement 1980;59:37‐9. - PubMed
Offer 1988 {published data only}
    1. Offer C, Weuta H, Bodner E. Efficacy of preoperative with ciprofloxacin or cefazolin in colorectal surgery. Infection 1988;16(Suppl 1):46‐7. - PubMed
Ofstad 1980 {published data only}
    1. Ofstad E, Brabrand G, Helsingen N, Uggerud R, Jorgensen J, Lien E, et al. Tinidazole and doxycycline as antimicrobials in elective colorectal surgery. A randomized multicentre trial. Scandinavian Journal of Gastroenterology. Supplement 1980;59:29‐35. - PubMed
Olsen 1983 {published data only}
    1. Olsen PR, Andersen HH, Hebjorn M, Pedersen VM, Hansen LK. The prophylaxis of metronidazole in colorectal surgery. Danish Medical Bulletin 1983;30(5):345‐8. - PubMed
Pacelli 1991 {published data only}
    1. Pacelli F, Brisinda G, Bellantone R, Doglietto GB, Crucitti F. Single dose imipenem‐cilastatin compared with three doses of cefuroxime and metronidazole as prophylaxis in elective colorectal surgery: a prospective randomized study. Journal of Chemotherapy 1991;3(6):372‐5. - PubMed
Palla 1989 {published data only}
    1. Palla Garcia J, Consiglieri Pedroso J. Ceftriaxone single dose versus ceftazidime multiple doses in the prophylaxis of infection in colorectal surgery. European Surgical Research 1989;21(Suppl 1):14‐8. - PubMed
Panichi 1982 {published data only}
    1. Panichi G, Pantosti A, Giunchi G, Tonelli F, D'Amicis P, Fegiz G, et al. Cephalothin, cefoxitin, or metronidazole in elective colonic surgery? A single‐blind randomized trial. Diseases of the Colon and Rectum 1982;25(8):783‐6. - PubMed
Park 2010 {published data only}
    1. Park JW, Oh JH, Choi HS, Yoo S‐B, Choe Y‐J, Park S, et al. A prospective, multicenter, randomized trial for duration of the prophylactic antibiotics after elective colorectal surgery: 3 days versus 5 days. Journal of the Korean Society of Coloproctology 2010;26(2):123‐8.
Peiper 1996 {published data only}
    1. Peiper C, Seelig M, Schumpelick V. Low dose perioperative antibiotic prophylaxis in colorectal surgery. A prospective randomized study in 60 patients [Stellenwert der niedrig dosierten perioperativen antibiotikaprophylaxe bei kolorektalen eingriffen. Eine prospektive randomisierte studie an 60 patienten]. Aktuelle Chirurgie 1996;31(3):164‐7.
Peiper 1997 {published data only}
    1. Peiper C, Seelig M, Treutner KH, Schumpelick V. Low‐dose, single‐shot perioperative antibiotic prophylaxis in colorectal surgery. Chemotherapy 1997;43(1):54‐9. - PubMed
Periti 1989 {published data only}
    1. Periti P, Mazzei T, Tonelli F. Single‐dose cefotetan vs. multiple‐dose cefoxitin‐antimicrobial prophylaxis in colorectal surgery. Results of a prospective, multicenter, randomised study. Diseases of the Colon and Rectum 1989;32(2):121‐7. - PubMed
Periti 1993 {published data only}
    1. Periti P, Tonelli F, Mazzei T, Ficari F. Antimicrobial chemoimmunoprophylaxis in colorectal surgery with cefotetan and thymostimulin: prospective controlled multicenter study. Italian Study Group on Antimicrobial Prophylaxis in Abdominal Surgery. Journal of Chemotherapy 1993;5(1):37‐42. - PubMed
Perrott 1985 {published data only}
    1. Perrott CAV, Hinder RA, Cassel R, Koornhof HJ, Naude G, Kleinman M, et al. Prophylactic antimicrobials in elective colorectal and biliary surgery. South African Medical Journal 1985;68:387‐91. - PubMed
Peruzzo 1987 {published data only}
    1. Peruzzo L, Savio S, Lalla FD. Systematic versus systematic plus oral chemoprophylaxis in elective colorectal surgery. Chemioterapia 1987;6:601‐2. - PubMed
Petermann 1983 {published data only}
    1. Petermann C, Wesch G, Saeger HD, Linder MM. The significance of anaerobes for perioperative antibiotic prophylaxis in elective colorectal surgery [Die Bedeutung der Anaerobier fur die perioperative Antibioticaprophylaxe bei elektiver colorectaler Chirurgie]. Langenbecks Archiv fur Chirurgie 1983;359(Suppl):63‐7.
Petrelli 1988 {published data only}
    1. Petrelli NJ, Conte CC, Herrera L, Stulc J, O'Neill P. A prospective trial of preoperative prophylactic cefamandole in elective colorectal surgery for malignancy. Diseases of the Colon and Rectum 1988;31(6):427‐9. - PubMed
Petropoulos 1985 {published data only}
    1. Petropoulos P, Dietrich PY, Ammann J, Ayer G, Buchmann P, Martinoli S. Single‐dose antibiotic prophylaxis for elective colorectal surgery. Multicenter study in Switzerland [Prophylaxie antibiotique par dose unique pour la chirurgie colo‐rectale elective]. Helvetica Chirurgica Acta 1985;52:703‐6. - PubMed
Playforth 1987 {published data only}
    1. Playforth MJ, Smith GMR, Evans M, Pollock AV. Single‐dose intravenous antibiotics for the prophylaxis of abdominal surgical wound infection: a trial of amoxycillin/clavulanate against latamoxef. Surgical Research Communications 1987;1:173‐80.
Playforth 1988 {published data only}
    1. Playforth MJ, Smith GMR, Evans M, Pollock AV. Antimicrobial bowel preparation: oral, parenteral or both?. Diseases of the Colon and Rectum 1988;31(2):90‐3. - PubMed
Plouffe 1985 {published data only}
    1. Plouffe JF, Perkins RL, Fass RJ, Carey LC, Macynski ME. Comparison of the effectiveness of moxalactam and cefazolin in the prevention of infection in patients undergoing abdominal operations. Diagnostic Microbiology and Infectious Disease 1985;3:25‐31. - PubMed
Plouffe 1989 {published data only}
    1. Plouffe JF. Cefmetazole versus cefoxitin in prevention of infections after abdominal surgery. Journal of Antimicrobial Chemotherapy 1989;23(Suppl D):85‐8. - PubMed
Pollock 1989 {published data only}
    1. Pollock AV, Evans M, Smith GMR. Preincisional intraparietal Augmentin in abdominal operations. Annals of the Royal College of Surgeons of England 1989;71:97‐100. - PMC - PubMed
Proud 1979 {published data only}
    1. Proud G, Chamberlain J. Antimicrobial prophylaxis in elective colonic surgery. Lancet 1979; Vol. 2, issue 8150:1017‐8. - PubMed
Raetzel 1986 {published data only}
    1. Raetzel G, Harnoss BM, Görtz G, Häring R, Rodloff A. Systemic antibiotic prophylaxis with metronidazole in elective colonic and rectal surgery. Results of a clinical controlled study and a critical literature review [Systemische Antibiotikaprophylaxe mit Metronidazol in der elektiven Kolon‐ und Rektumchirurgie. Ergebnisse einer klinisch‐kontrollierten Studie und kritische Literaturübersicht]. Arzneimittel‐Forschung 1986;36(6):976‐80. - PubMed
Rangabashyam 1991 {published data only}
    1. Rangabashyam N, Rathnasami A. Prophylaxis of infection following colorectal surgery. Infection 1991;19(6):459‐61. - PubMed
Reers 1989 {published data only}
    1. Reers B, Winde G, Sulkowski U, Blum M. Single‐dose prophylaxis in elective colorectal surgery: a prospective, randomized trial with piperacillin or latamoxef. Journal of Chemotherapy 1989;1(4 Suppl):997‐8. - PubMed
Renner 1989 {published data only}
    1. Renner H, Losch H. Experiences with ceftriaxone (Rocephin) in perioperative antibiotic prophylaxis for elective colon surgery. Journal of Chemotherapy (Florence, Italy) 1989;1(4 Suppl):1005‐6. - PubMed
Reynolds 1989 {published data only}
    1. Reynolds JR, Jones JA, Evans DF, Hardcastle JD. Do preoperative oral antibiotics influence sepsis rates following elective colorectal surgery in patients receiving perioperative intravenous prophylaxis. Surgical Research Communications 1989;7:71‐7.
Rodolico 1991 {published data only}
    1. Rodolico G, Puelo S, Blandono G, Russello D, Amoedo C, Latteri F, et al. Colorectal surgery: short‐term prophylaxis with clindamycin plus aztreonam or gentamicin. Reviews of Infectious Diseases 1991;13(7):612‐5. - PubMed
Roland 1985 {published data only}
    1. Roland M, Bergan T, Bjerkeset T, Erichsen H, Hoel R, Johansen S, et al. Prophylactic regimens in colorectal surgery: comparisons between metronidazole used alone or with ampicillin for one or three days. World Journal of Surgery 1985;9(4):626‐32. - PubMed
Roland 1985a {published data only}
    1. Roland M, Bergan T, Bjerkeset T, Erichsen H, Hoel R, Johansen S, et al. Prophylactic regimens in colorectal surgery: comparisons between metronidazole used alone or with ampicillin for one or three days. World Journal of Surgery 1985;9(4):626‐32. - PubMed
Roland 1986 {published data only}
    1. Roland M. Prophylactic regimens in colorectal surgery: An open, randomised, consecutive trial on metronidazole used alone or in combination with ampicillin or doxycycline. World Journal of Surgery 1986;10:1003‐8. - PubMed
Rorbaek‐Madsen 1988 {published data only}
    1. Rorbaek‐Madsen M, Toftgaard C, Graversen HP, Kristiansen JD, Lauesen N, Randberg FA, et al. Cefoxitin for one day versus ampicillin and metronidazole for three days in elective colorectal surgery. Diseases of the Colon and Rectum 1988;31(10):774‐7. - PubMed
Rosenberg 1971 {published data only}
    1. Rosenberg IL, Graham NG, Dombal FT, Goligher JC. Preparation of the intestine in patients undergoing major large‐bowel surgery, mainly for neoplasms of the colon and rectum. British Journal of Surgery 1971;58(4):266‐9. - PubMed
Rowe‐Jones 1990 {published data only}
    1. Rowe‐Jones DC, Peel ALG, Kingston RD, Shaw JFL, Teasdale C, Cole DS. Single dose cefotaxime plus metronidazole versus three dose cefuroxime plus metronidazole as prophylaxis against wound infection in colorectal surgery: multicentre prospective randomised study. BMJ 1990;300:18‐22. - PMC - PubMed
Ryan 1986 {published data only}
    1. Ryan PJ, Fink RLW, Ross Hetal. Clinical trial of prophylaxis of wound sepsis in elective colorectal surgery comparing ticarcillin with tinidazole. Australian and New Zealand Journal of Surgery 1986;56(3):209‐13. - PubMed
Sato 2009 {published data only}
    1. Sato T, Takayama T, Fujii M, Song K, Matsuda M, Higaki T, et al. Systemic use of antibiotics does not prevent postoperative infection in elective colorectal surgery: a randomized controlled trial. Journal of Infection & Chemotherapy 2009;15(1):34‐8. - PubMed
Sauven 1986 {published data only}
    1. Sauven P, Playforth MJ, Smith GMR, Evans M, Pollock AV. Single‐dose antibiotic prophylaxis of abdominal surgical wound infection: a trial of preoperative latamoxef against preoperative tetracycline lavage. Journal of the Royal Society of Medicine 1986;79:137‐41. - PMC - PubMed
Schiessel 1984 {published data only}
    1. Schiessel R, Huk I, Wunderlich M, Rotter M, Wewalka G, Schemper M. Postoperative infections in colonic surgery after enteral bacitracin‐neomycin‐clindamycin or parenteral mezlocillin‐oxacillin prophylaxis. Journal of Hospital Infection 1984;5:289‐97. - PubMed
Schneiders 1976 {published data only}
    1. Schneiders H, Haralambie E, Towfigh H, Eigler FW, Linzenmeier G. Effectiveness of antibiotic premedication in colonic surgery [German] [Uber die Wirksamkeit der Antibioticavorbereitung in der Colonchirurgie]. Chirurg 1976;47(1):33‐8. - PubMed
Schoetz 1990 {published data only}
    1. Schoetz DJ Jr, Roberts PL, Murray JJ, Coller JA, Veidenheimer MC. Addition of parenteral cefoxitin to regimen of oral antibiotics for elective colorectal operations. Annals of Surgery 1990;212(2):209‐12. - PMC - PubMed
Shatney 1984 {published data only}
    1. Shatney CH. Antibiotic prophylaxis in elective gastro‐intestinal tract surgery: a comparison of single‐dose pre‐operative cefotaxime and multiple‐dose cefoxitin. Journal of Antimicrobial Chemotherapy 1984;14(Suppl B):241‐5. - PubMed
Shimizu 2010 {published data only}
    1. Shimizu J, Ikeda K, Fukunaga M, Murata K, Miyamoto A, Umeshita K, et al. Multicenter prospective randomized phase II study of antimicrobial prophylaxis in low‐risk patients undergoing colon surgery. Surgery Today 2010;40(10):954‐7. - PubMed
Skipper 1992 {published data only}
    1. Skipper D, Karran SJ. A randomized prospective study to compare cefotetan with cefuroxime plus metronidazole as prophylaxis in elective colorectal surgery. Journal of Hospital Infection 1992;21:72‐7. - PubMed
Slama 1979 {published data only}
    1. Slama TG, Carey LC, Fass RJ. Comparative efficacy of prophylactic cephalothin and cefamandole for elective colon surgery: results of a prospective, randomized, double‐blind study. American Journal of Surgery 1979;137(5):593‐6. - PubMed
Solhaug 1983 {published data only}
    1. Solhaug JH, Bergman L, Kylberg F. A randomized evaluation of single dose chemoprophylaxis in elective colorectal surgery ‐ a comparison between metronidazole and doxycycline. Annals of Clinical Research 1983;15(1):15‐20. - PubMed
Stellato 1990 {published data only}
    1. Stellato TA, Danziger LH, Gordon N, Hau T, Hull CC, Zollinger RM, et al. Antibiotics in elective colon surgery. The American Surgeon 1990;56:251‐4. - PubMed
Stewart 1995 {published data only}
    1. Stewart M, Taylor EW, Lindsay G, West of Scotland Surgical Infection Study Group. Infection after colorectal surgery: a randomised trial of prophylaxis with piperacillin versus sulbactam/pipercillin. Journal of Hospital Infection 1995;29:135‐42. - PubMed
Stubbs 1987 {published data only}
    1. Stubbs RS, Griggs NJ, Kelleher JP, Dickinson IK, Moat N, Rimmer DMD. Single dose mezlocillin versus three dose cefuroxime plus metronidazole for the prophylaxis of wound infection after large bowel surgery. Journal of Hospital Infection 1987;9:285‐90. - PubMed
Suzuki 2011 {published data only}
    1. Suzuki T, Sadahiro S, Maeda Y, Tanaka A, Okada K, Kamijo A. Optimal duration of prophylactic antibiotic administration for elective colon cancer surgery: A randomized, clinical trial. Surgery 2011;149(2):171‐8. - PubMed
Takesue 2000 {published data only}
    1. Takesue Y, Yokoyama T, Akagi S, Ohge H, Murakami Y, Sakashita Y, et al. A brief course of colon preparation with oral antibiotics. Surgery Today 2000;30(2):112‐6. - PubMed
Taylor 1994 {published data only}
    1. Taylor EW, Lindsay G, West of Scotland Surgical Infection Study Group. Selective decontamination of the colon before elective colorectal surgery. World Journal of Surgery 1994;18:926‐32. - PubMed
Tehan 1989 {published data only}
    1. Tehan S, Whittaker J. A multi‐centre double‐blind prospective study comparing the efficacy and tolerance of Augmentin with the combination of cephradine plus metronidazole as surgical prophylaxis. Surgical Research Communications 1989;6:97‐105.
Thomas 1985 {published data only}
    1. Thomas WEG, Cooper MJ, Holt A, Reeves D. Latamoxef: single agent prophylaxis in colorectal surgery. Journal of Antimicrobial Chemotherapy 1985;16:121‐8. - PubMed
Tornqvist 1981 {published data only}
    1. Tornqvist A, Ekelund G, Forsgren A. Single dose doxycycline prophylaxis and peroperative bacteriological culture in elective colorectal surgery. British Journal of Surgery 1981;68(8):565‐8. - PubMed
Tsimoyiannis 1991 {published data only}
    1. Tsimoyiannis EC, Paizis JB, Kabbani K, Lekkas ET, Floras GA, Boulis SA. Short‐term antibiotic prophylaxis in elective colorectal surgery. Chemotherapy 1991;91(37):66‐9. - PubMed
Tuchmann 1988 {published data only}
    1. Tuchmann V, Breyer S, Ganzinger U. Antibiotic prophylaxis in colorectal surgery, short‐term vs one‐shot prophylaxis ‐ a multicentre study. Fortschritt Medizin 1988;106(26):537‐60. - PubMed
Ulrich 1981 {published data only}
    1. Ulrich C. 24‐hour systemic antibiotic prophylaxis in large‐bowel surgery. Netherlands Journal of Surgery 1981;33(1):3‐9. - PubMed
University 1987 {published data only}
    1. University of Melbourne Colorectal Group. Systematic Timentin is superior to oral tinidazole for antibiotic prophylaxis in elective colorectal surgery. Diseases of the Colon and Rectum 1987;30(10):786‐9. - PubMed
University 1989 {published data only}
    1. University of Melbourne Colorectal Group. A comparison of single‐dose systematic Timentin with mezlocillin for prophylaxis of wound infection in elective colorectal surgery. Diseases of the Colon and Rectum 1989;32(11):940‐3. - PubMed
Utley 1984 {published data only}
    1. Utley RJ, Macbeth WAAG. Preoperative cefoxitin. A double‐blind prospective study in the prevention of wound infection. Journal of the Royal College of Surgeons of Edinburgh 1984;29(3):143‐6. - PubMed
Vacher 1990 {published data only}
    1. Vacher B, Rodary M, Hay JM, Fingerhut A. Colorectal preparation for excision surgery. Development after 4 randomized multicenter studies [Préparation colo‐rectale à la chirurgie d'exérèse. Evolution après 4 études multicentriques randomisées.]. Chirurgie; Mémoires de l'Académie de Chirurgie 1990; Vol. 116, issue 4‐5:409‐14. - PubMed
Vallance 1980 {published data only}
    1. Vallance S, Jones B, Arabi Y, Keighley MR. Importance of adding neomycin to metronidazole for bowel preparation. Journal of the Royal Society of Medicine 1980;73(4):238‐40. - PMC - PubMed
Vallent 1983 {published data only}
    1. Vallent K, Bodnar A, Weltner J. Experience with intravenous metronidazole administration in the preoperative care of surgery of the large intestine [German] [Erfahrungen mit intravenoser Metronidazolgabe bei der Vorbereitung zu Dickdarmoperationen]. Zentralblatt fur Chirurgie 1983;108(20):1293‐8. - PubMed
Vargish 1978 {published data only}
    1. Vargish T, Crawford LC, Stallings RA, Wasilauskas BL, Myers RT. A randomized prospective evaluation of orally administered antibiotics in operations on the colon. Surgery, Gynecology & Obstetrics 1978;146(2):193‐8. - PubMed
Viddal 1980 {published data only}
    1. Viddal KO, Semb LS. Tinidazole and doxycycline compared to doxycycline alone as prophylactic antimicrobial agents in elective colorectal surgery. Scandinavian Journal of Gastroenterology. Supplement 1980;59:21‐4. - PubMed
Walker 1988 {published data only}
    1. Walker AJ, Taylor EW, Lindsay G, Dewar EP. A multicentre study to compare piperacillin with the combination of netilmicin and metronidazole for prophylaxis in elective colorectal surgery undertaken in district general hospitals. Journal of Hospital Infection 1988;11(4):340‐8. - PubMed
Wapnick 1979 {published data only}
    1. Wapnick S, Guinto R, Reizis I, LeVeen HH. Reduction of postoperative infection in elective colon surgery with preoperative administration of kanamycin and erythromycin. Surgery 1979;85(3):317‐21. - PubMed
Watt‐Boolsen 1979 {published data only}
    1. Watt‐Boolsen S, Justesen T, Blichert‐Toft M, Hansen JB. The prophylaxis of septic complications in colo‐rectal surgery. A controlled trial of metronidazole and oxytetracycline. Acta Chirurgica Scandinavica 1979;145(4):263‐6. - PubMed
Weaver 1986 {published data only}
    1. Weaver M, Burdon DW, Youngs DJ, Keighley MRB. Oral neomycin and erythromycin compared with single‐dose systematic metronidazole and ceftriaxone prophylaxis in elective colorectal surgery. American Journal of Surgery 1986;15(1):437‐41. - PubMed
Weidema 1985 {published data only}
    1. Weidema WF, Boogaard AE, Wesdorp RI, Boven CP, Greep JM. 24‐hour systematic prophylaxis with gentamicin and metronidazole, or metronidazole alone, in elective colorectal surgery after mechanical bowel preparation with mannitol and whole gut irrigation. Acta Chirurgica Belgica 1985;85:349‐53. - PubMed
Wenzel 1982 {published data only}
    1. Wenzel M, Walden M, Heinrich M, Neuhaus B. Systemic mezlocillin prophylaxis in elective colon surgery [German] [Die systemische Mezlocillin‐Prophylaxe in der elektiven Kolonchirurgie]. Infection 1982;10(Suppl 3):148‐57. - PubMed
Wenzel 1983 {published data only}
    1. Wenzel M, Schmidt C, Walden M. Systemic mezlocillin prophylaxis in elective colon surgery [Die systemische Mezlocillin Prophylaxe in der elektiven Kolonchirurgie]. Medizinische Welt 1983;34(35):934‐40. - PubMed
Wenzel 1983a {published data only}
    1. Wenzel M, Schmidt C, Walden M. Systemic mezlocillin prophylaxis in elective colon surgery [Die systemische Mezlocillin Prophylaxe in der elektiven Kolonchirurgie]. Medizinische Welt 1983;34(35):934‐40. - PubMed
Wenzel 1985 {published data only}
    1. Wenzel M, Heinrich M, Schmidt C. Peri‐operative infection prophylaxis with ornidazole and gentamicin in elective colonic surgery. Pharmatherapeutica 1985;4(6):351‐5. - PubMed
Wetterfors 1980 {published data only}
    1. Wetterfors J, Hoejer H. Prophylaxis with doxycycline (Vibramycin) in colorectal surgery. Scandinavian Journal of Gastroenterology. Supplement 1980;59:12‐6. - PubMed
Willis 1977 {published data only}
    1. Willis AT, Ferguson IR, Jones PH, Phillips KD, Tearle PV, Fiddian RV, et al. Metronidazole in prevention and treatment of bacteroides infections in elective colonic surgery. British Medical Journal 1977;1(6061):607‐10. - PMC - PubMed
Winker 1983 {published data only}
    1. Winker H, Dortenmann J, Wittmann DH. Infection prevention in elective large intestine surgery. Results of a prospective randomized comparative study. Chirurg 1983;54(4):272‐7. - PubMed
Wohlfahrt 1987 {published data only}
    1. Wohlfahrt R, Siedek M. Perioperative infection prophylaxis in colon surgery. Chemioterapia 1987;6:603‐5. - PubMed
Yabata 1997 {published data only}
    1. Yabata E, Okabe S, Endo M. A prospective, randomized clinical trial of preoperative bowel preparation for elective colorectal surgery‐comparison among oral, systemic, and intraoperative luminal antibacterial preparations. Journal of Medical & Dental Sciences 1997;44(4):75‐80. - PubMed
Yip 1994 {published data only}
    1. Yip AWC. Comparison of prophylactic ampicillin/sulbactam with gentamicin and metronidazole in elective colorectal surgery: A randomized clinical study. Journal of Hospital Infection 1994;27(2):149‐54. - PubMed
Zanella 2000 {published data only}
    1. Zanella E, Rulli F and the 230 Study Group. A multicenter randomized trial of prophylaxis with intravenous cefepime + metronidazole or ceftriaxone + metronidazole in colorectal surgery. Journal of Chemotherapy 2000;12(1):63‐71. - PubMed
Zelenitsky 2000 {published data only}
    1. Zelenitsky SA, Silverman RE, Duckworth H, Harding GKM. A prospective, randomized, double‐blind study of single high dose versus multiple standard dose gentamicin both in combination with metronidazole for colorectal surgical prophylaxis. Journal of Hospital Infection 2000;46:135‐40. - PubMed
Zuber 1989 {published data only}
    1. Zuber M, Durig M, Neff U, Laffer U. Antibiotic prophylaxis in colorectal surgery: cefazolin‐ornidazole versus cefazolin‐placebo [German]. Helvetica Chirurgica Acta 1989;56:211‐5. - PubMed

References to studies excluded from this review

Anonymous 1988 {published data only}
    1. Anonymous. Infectious problems in elective non‐colorectal abdominal surgery. The Norwegian Gastro‐Intestinal Group (NORGAS). Current Medical Research and Opinion 1988;11(3):159‐70. - PubMed
Baker 1994 {published data only}
    1. Baker DM, Jones JA, Nguyen‐Van‐Tam JS, Lloyd JH, Morris DL, Bourke JB, et al. Taurolidine peritoneal lavage as prophylaxis against infection after elective colorectal surgery. British Journal of Surgery 1994;81(7):1054‐6. - PubMed
Baracs 2011 {published data only}
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Bartlett 1983 {published data only}
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Bennett‐Guerrero 2010 {published data only}
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Burdon 1977 {published data only}
    1. Burdon JG, Morris PJ, Hunt P, Watts JM. A trial of cephalothin sodium in colon surgery to prevent wound infection. Archives of Surgery 1977;112(10):1169‐73. - PubMed
Burton 1975 {published data only}
    1. Burton RC, Hughes ES, Cuthbertson AM. Prophylactic use of gentamicin in colonic and rectal surgery. Medical Journal of Australia 1975;2(15):597‐9. - PubMed
Cazzaniga 1980 {published data only}
    1. Cazzaniga A, Perazzoli G, Boerchi A. Use of oral antibiotics association in elective colon surgery [L'uso di associazioni antibiotiche nella preparazione orale del colon all'intervento chirurgico. Confronto tra neomicina‐eritromicina e neomicina‐tetraciclina]. Chirurgia 1980;4(1):103‐13.
Champault 1981 {published data only}
    1. Champault G. Pre‐operative preparation of the colon: A controlled prospective multicentre study in 215 patients [La preparation colique a la chirurgie. Etude multicentrique prospective controlee (215 cas)]. Journal de Chirurgie 1981;118(11):677‐84. - PubMed
Charalambous 2003 {published data only}
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Claesson 1981 {published data only}
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Cleary 1998 {published data only}
    1. Cleary RK, Grossmann R, Fernandez FB, Stull TS, Fowler JJ, Walters MR, et al. Metronidazole may inhibit intestinal colonization with Clostridium difficile. Diseases of the Colon and Rectum 1998;41(4):464‐7. - PubMed
Davey 1995 {published data only}
    1. Davey PG, Parker SE, Crombie IK, Jaderberg M. The cost effectiveness of amoxicillin/clavulanic acid as antibacterial prophylaxis in abdominal and gynaecological surgery. Pharmacoeconomics 1995;7(4):347‐56. - PubMed
Davey 1998 {published data only}
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De Lalla 2009 {published data only}
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Devecioglu 1990 {published data only}
    1. Devecioglu S, Tuylu Y, Zissis NP. Piperacillin prophylaxis in colorectal surgery. A randomized comparative evaluation of two dosage schedules. Saudi Medical Journal 1990;11(5):385‐8.
Dionigi 1989 {published data only}
    1. Dionigi R, Mozzillo N, Ventriglia L. Comparative multicenter study on efficacy and safety of aztreonam and gentamicin in prophylaxis of high‐risk colorectal surgery. Journal of Chemotherapy (Florence, Italy) 1989;1(Suppl 2):22‐7. - PubMed
Eisenberg 1981 {published data only}
    1. Eisenberg HW. Cefamandole preparation for colonic surgery. Diseases of the Colon and Rectum 1981;24(8):610‐2. - PubMed
Feathers 1977 {published data only}
    1. Feathers RS, Sagor GR, Lewis AA, Amirak ID, Noone P. Prophylactic systemic antibiotics in colorectal surgery. Lancet 1977;2(8027):4‐8. - PubMed
Fielding 1985 {published data only}
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Galandiuk 1989 {published data only}
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Hall 1987 {published data only}
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Hares 1981 {published data only}
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References to studies awaiting assessment

Mecchia 2000 {published data only}
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