PROPHYLACTIC ANTIBIOTICS FOR COLOSTOMY CLOSURE IN CHILDREN - SHORT VERSUS LONG COURSE


AKGUR F., TANYEL F., BUYUKPAMUKCU N., HICSONMEZ A.

PEDIATRIC SURGERY INTERNATIONAL, vol.7, no.4, pp.279-281, 1992 (SCI-Expanded) identifier

  • Publication Type: Article / Article
  • Volume: 7 Issue: 4
  • Publication Date: 1992
  • Journal Name: PEDIATRIC SURGERY INTERNATIONAL
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.279-281
  • Keywords: PROPHYLACTIC ANTIBIOTICS, COLORECTAL SURGERY, COLOSTOMY CLOSURE
  • Dokuz Eylül University Affiliated: Yes

Abstract

A prospective, randomized clinical study was performed to compare the results of 1-day versus 7-day administration of the same prophylactic antibiotics to 30 consecutive patients undergoing colostomy closure. The antibiotics used were cotrimoxazole (8 mg/kg per day trimethoprim) and ornidazole (20 mg/kg per day), which were this department's standard prophylactic agents for colorectal surgery. Patients, in the first group received cotrimoxazole i.m. 1 h before the operation and ornidazole by i. v. infusion starting after induction of anesthesia. The same dosages of both drugs were repeated once 12 h after the initial dose. In the second group (7 days), both agents were started orally 48 h before the operation. The preoperative doses were given as in the short-course group and were continued in this fashion until the end of the 5th postoperative day. Mechanical cleansing of the bowel and the operative procedure were standardized for all patients. Intraluminal swab cultures were obtained during the operation; only aerobic cultures could be studied. Patients were closely monitored for septic complications during the postoperative period. Study groups were similar regarding age, sex, nutritional status, and micro-organisms isolated from the bowel. Wound infections confined to the subcutaneous tissue occurred in 2 patients, 1 in each group (6.6%). No intraperitoneal infection, anastomotic leakage/dehiscence, or wound dehiscence was encountered. While susceptibilities to antibiotics other than cotrimoxazole were similar in both groups, cotrimoxazole-resistant micro-organisms were found more often in the long-course group (P <0.05). Because we found no difference in the rate of infectious complications between groups, we recommend the use of short-term parenteral antibiotic prophylaxis for colostomy closure in children. Such an approach saves nursing time, reduces costs, and prevents the formation of bacterial resistance.