Colorectal surgery

Rifaximin Rifamycin Antibiotic Gut bacteria Enteric infection Diarrhea, infectious Hepatic encephalopathy Small intestine bacterial overgrowth Inflammatory bowel disease Colonic diverticular disease Irritable bowel syndrome Constipation Clostridium difficile infection Helicobacter pylori infection Colorectal surgery Bowel decontamination, selective Pancreatitis, acute Bacterial peritonitis, spontaneous Nonsteroidal anti-inflammatory drug enteropathy... 

Bowel preparation before colorectal surgery H. pylori infection... 

Bucher P, Mermillod B, Morel P, Soravia C Does mechanical bowel preparation have a role in preventing postoperative complications in elective colorectal surgery Swiss Med Wkly 2004 134 69-74. 

Gorbach SL Antimicrobial prophylaxis for appendectomy and colorectal surgery. Rev Infect Dis 1991 13(suppl 10) S815-S820. 

Salcuni PE, Palazzini E An evaluation of the therapeutic activity and tolerance of rifaximin, administered by stomach probe, in patients after colorectal surgery. Aggiornamenti Med Chir 1988 6 1-7. 

Rifaximin is available in Europe for the treatment of acute intestinal bacterial infections, hepatic encephalopathy, bacterial overgrowth syndrome, diverticular disease of the colon, and for the prevention of infections after colorectal surgery [3, 4]. Rifaximin is also licensed in Mexico, Asia and Northern Africa and has recently been approved in USA for the treatment of traveler s diarrhea. 

Krager L, Liljeqvist L, Malmborg AS, Nord CE, Pieper R Effects of ampicillin plus sulbactam on bowel flora in patients undergoing colorectal surgery. Antimicrob Agents Chemother 1982 22 208-212. 

Van den Bogaard AE, Weidema WF, van Bo-ven CP, van der Waay D Recolonization and colonization resistance of the large bowel after three methods of preoperative preparation of the gastrointestinal tract for elective colorectal surgery. J Hyg(Lond) 1986 97 49-59. 

Cavallaro V, Catania V, Bonaccorso R, Maz-zone S, Seciale A, Di Marco R, Blandino G, Caccamo F Effect of a broad-spectrum cephalosporin on the oral and intestinal microflora in patients undergoing colorectal surgery. J Chemother 1992 4 82-87. 

Zmora O, Pikarsky AJ, Wexner SD Bowel preparation for colorectal surgery. Dis Colon Rectum 2001 44 1537-1549. 

Platell C, Hall J What is the role of mechanical bowel preparation in patients undergoing colorectal surgery. Dis Colon Rectum 1998 41 875-882. 

Miettinen RP, Laitinen ST, Markela JT, Paak-konen ME Bowel preparation with oral polyethylene glycol electrolyte solution vs. no preparation in elective open colorectal surgery Prospective, randomized study. Dis Colon Rectum 2000 43 669-675. 

Brownson P, Jenkins SA, Nott D, Ellenbogen S Mechanical bowel preparation before colorectal surgery Results of a prospective randomized trial. Br J Surg 1992 79 461-462. 

Santos JCM, Batista J, Sirimarco MT, Guima-racs AS, Levy CE Prospective randomized trial of mechanical bowel preparation in patients undergoing elective colorectal surgery. Br J Surg 1994 81 1673-1676. 

Van Geldere D, Fa-Si-Oen P, Noach LA, Rie-tra PJ, Peterse JL, Boom RP Complications after colorectal surgery without mechanical bowel preparation. J Am Coll Surg 2002 194 40-47. 

Frazee RC, Roberts J, Symmonds R, Snyder S, Hendricks J, Smith R Prospective randomized trial of inpatient vs. outpatient bowel preparation for elective colorectal surgery. Dis Colon Rectum 1992 35 223-226. 

Jagelman DG, Fabian TC, Nichols RL, Stone HH, Wilson SE, Zellner SR Single-dose cefote-tan versus multiple dose cefoxitin as prophylaxis in colorectal surgery. Am J Surg 1988 155(suppl 5A) 71-76. 

Song F, Glenny AM Antimicrobial prophylaxis in colorectal surgery A systematic review of randomized controlled trials. Br J Surg 1998 ... 

Pursuant to editorial request, an additional literature search of relevant articles pertaining to the need for preoperative mechanical and antimicrobial bowel preparation in colorectal surgery since the time of... 

Zmora O, Wexner SD, Hajjar L, Park T, Efron JE, Nogueras JJ, Weiss EG Trends in preparation for colorectal surgery Survey of the members of the American society of colon and rectal surgeons. Am Surg 2003,69 150-154. 

Wille-Jorgensen P, Guenaga KF, Castro AA, Matos D Clinical value of preoperative mechanical bowel cleansing in elective colorectal surgery A systematic review. Dis Colon Rec-tum 2003 46(8) 1013-1018. 

Colorectal surgery 2 g single dose 30 to 90 min before surgery or 2 g doses 30 to 90 min before surgery and repeated 8 to 16 h later. 

Prophylaxis To prevent postoperative infection in contaminated or potentially contaminated colorectal surgery, the recommended adult dosage is 15 mg/kg infused over 30 to 60 minutes and completed about 1 hour before surgery followed by 7.5 mg/kg infused over 30 to 60 minutes at 6 and 12 hours after the initial dose. Complete administration of the initial preoperative dose about 1 hour before surgery so that adequate drug levels are present in the serum and tissues at the time of initial incision, and administer, if necessary, at 6-hour intervals to maintain effective drug levels. Limit prophylactic use to the day of surgery only. 

A combination of neomycin and nonabsorbable erythromycin base given orally prior to colorectal surgery can markedly reduce the incidence of postoperative wound infection. Orally administered neomycin is sometimes used to suppress the facultative flora of the gut in patients with hepatic encephalopathy. It is unclear how this improves coma, but one theory is that it reduces systemic absorption of the bacterial metabo-htes that allegedly cause hepatic encephalopathy. Although more than 95% of an oral dose of neomycin is excreted unchanged in the stool of normal subjects, the bioavaUabUity of neomycin may be much higher in patients with an abnormal gastrointestinal mucosa. 

Chen JY, Wu GJ, Mok MS, et al. Effect of adding ketorolac to intravenous morphine patient-controlled analgesia on bowel function in colorectal surgery patients—a prospective, randomized, double-blind study. Acta Anaesthesiol Scand. 2005 49 546-551. 

Combination therapy is often used when dealing with infections caused by both aerobic and anaerobic bacteria [50,80]. Combination of metronidazole with either gentamicin or ciprofloxacin appeared to be effective in preventing infection of abdominal trauma [101] when combined with ciprofloxacin, metronidazole was affective as a preoperative antibiotic in colorectal surgery and appeared equal in efficacy to impipenem/cilastin for the treatment of complicated intraabdominal infections [103]. Combination therapy is not always indicated for the treatment of polymicrobial infections. New antibiotics, whose spectrum includes multiple classes of microorganisms (e.g., imipenem), may often preclude combination therapy. 

Colorectal surgery, because there is a high risk of infection with Escherichia coli, Clostridium spp, streptococci and Bacteroides spp which irrhabit the gut (a cephalosporin plus metronidazole, or benzylpenicillin plus gentamicin plus metronidazole are commonly used)... 

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