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Abstract
The effect of metronidazole prophylaxis in elective colonic and rectal surgery was
studied in a prospective double-blind trial in which metronidazole was compared with
a placebo. Fifty-six patients were included in the study, and the patients were randomly
allocated to the two groups. Twenty-five patients received 2 gm of metronidazole the
day before operation and 1.2 gm as a single daily dose for 5 days after operation.
Twenty-one patients were given placebos in the same dosage. Before operation all patients
were prepared with mechanical evacuation of the bowel. A significantly lower frequency
of wound sepsis, intraabdominal complications, and septicemia was found in the metronidazole
group as compared to the placebo group. The incidence was 4.0% and 36%, respectively.
Following protectomy, infection in the perineal area occurred in 33% and 43% of the
respective groups. In the metronidazole-treated patients, however, this was the only
complication, whereas 50% of the patients in the placebo group developed intraabdominal
complications as well. After operation anaerobic bacteria were isolated from 8% of
the patients who received prophylactic m.etronidazole. In the control group 67% of
the patients had a positive postoperative anaerobic culture. Bacteroides fragilis
was isolated from 13 of 14 patients with postoperative infection in the placebo group.
B. fragilis was not isolated from any of the metronidazole-treated patients. The study
indicates that anaerobic bacteria are the major contributors to wound infection following
colonic and rectal surgery and that metronidazole prophylaxis greatly reduces the
frequency of postoperative infection.
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Article info
Publication history
Accepted:
September 28,
1978
Identification
Copyright
© 1980 Published by Elsevier Inc.
