Clinical Case Database / Category: Prescribing

Antibiotics and bowel preparation in colorectal surgery

Publication details

HP Priyantha Siriwardana, Gordon N Buchanan
Foundation Years Journal, volume 2, issue 7, p.327 (123Doc Education, London, September 2008)


You are asked to see a 68-year-old gentleman with a history of an episode of heavy fresh bleeding per rectum and change in bowel habit to constipation. He is on aspirin and clopidogrel following his coronary stenting a year ago. He is also known to have diabetes mellitus type 2 on metformin and gliclazide. He is apyrexial; pulse rate is 96/minute and blood pressure is 124/71. There is mild tenderness in the left iliac fossa. Digital rectal examination and rigid sigmoidoscopy had revealed altered blood in the rectum. You note that his recent haemoglobin is 7.2 g/dl; white cell count is 13.2 and INR is 1.2.

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HP Priyantha Siriwardana (Corresponding author)

Colorectal Unit
Department of Surgery
East Surrey Hospital
Canada Avenue
Redhill RH1 5RH

Gordon N Buchanan

Department of Gastrointestinal Surgery
Charing Cross Hospital
Fulham palace Road
London W6 8RF


1. Mangram AJ, Horan TC, Pearson ML, et al. for the Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol,1999, 20:250–280.
2. Platell C, Hall J. What is the role of mechanical bowel preparation in patients undergoing colorectal surgery? Dis Colon Rectum, 1998, 41:875–882.
3. Polk HC Jr. Postoperative wound infection: prediction of some responsible organisms. Am J Surg, 1973, 126:592–594.
4. Clarke JS, Condon RE, Bartlett JG, et al. Preoperative oral antibiotics reduce septic complications of colon operations: results of prospective, randomized, double-blind clinical study. Ann Surg, 1977, 186:251–259.
5. Willis AT, Ferguson IR, Jones PH, et al. Metronidazole in prevention and treatment of bacteroides infections in elective colonic surgery. Br Med J, 1977, 1:607–610.
6. Goldring J, Scott A, McNaught W, Gillespie G. Prophylactic oral antimicrobial agents in elective colonic surgery. Lancet, 1975, 2:997–1000.
7. Clarke JS, Condon RE, Bartlett JG, et al. Preoperative oral antibiotics reduce septic complications of colon operations: results of prospective, randomized, double-blind clinical study. Ann Surg, 1977, 186:251–259.
8. Lau PW, Lo CY, Law WL. The role of one-stage surgery in acute left-sided colonic obstruction. Am J Surg, 1995, 169:406–409.
9. Song F, Glenny AM. Antimicrobial prophylaxis in colorectal surgery: a systematic review of randomized controlled trials. Br J Surg,1998, 85:1232–1241.
10. The Association of Coloproctology of Great Britain and Ireland: Guidelines for the management of colorectal cancer. London, Association of Coloproctology of Great Britain and Ireland, 2001.
11. Otchy D, Hyman NH, Simmang C, et al. Practice parameters for colon cancer. Dis Colon Rectum, 2004, 47:1269–1284.
12. Kehlet H, Williamson R, Buchler MW, Beart RW. A survey of perceptions and attitudes among European surgeons towards the clinical impact and management of postoperative ileus. Colorectal Dis, 2005, 7:245–250.
13. Zmora O, Wexner SD, Hajjar L, et al. 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.
14. Zanella E, Rulli F. The 230 Study Group. A multicenter randomized trial of prophylaxis with intravenous cefepime – metronidazole or ceftriaxone – metronidazole in colorectal surgery. J Chemother, 2000, 12:63–71.
15. Bratzler DW, Houck PM. Surgical Infection Prevention Guidelines Writers Workgroup, et al. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis, 2004, 38:1706–1715.
16. Wren SM, Ahmed N, Jamal A, Safadi BY. Preoperative oral antibiotics in colorectal surgery increase the rate of Clostridium difficile colitis. Arch Surg, 2005, 140:752–756.
17. Espin-Basany E, Sanchez-Garcia JL, Lopez-Cano M, et al. Prospective, randomised study on antibiotic prophylaxis in colorectal surgery: is it really necessary to use oral antibiotics? Int J Colorectal Dis, 2005, 20:542–546.
18. Bulmer M, Hartley J, Lee PW, et al. Improving the view in the rectal clinic: a randomised control trial. Ann R Coll Surg Engl, 2000, 82:210–212.
19. Lobo DN, Riddick ACP, Iftikhar SY, Gudgeon AM. Home rectal evacuation prior to colorectal clinic appointment; a prospective, randomised controlled, single-blind trial. Colorectal Disease. 1999, 1:158–161.
20. Gidwani AL, Makar R, Garrett D, Gilliland R. A prospective randomized single-blind comparison of three methods of bowel preparation for outpatient flexible sigmoidoscopy. Surg Endosc, 2007, 21:945–949.
21. Wexner SD, Beck DE, Baron TH, et al. Practice/Clinical Guidelines. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), 2006.
22. Jensch S, de Vries AH, Peringa J, et al. CT colonography with limited bowel preparation: performance characteristics in an increased-risk population. Radiology, 2008, 247:122–132.
23. Wille-Jørgensen P, Guenaga KF, Matos D, Castro AA. Pre-operative mechanical bowel cleansing or not? an updated meta-analysis. Colorectal Dis, 2005, 7:304–310.
24. Guenaga KF, Matos D, Castro AA, et al. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev, 2005, 25:CD001544. Review.
25. Platell C, Barwood N, Makin G. Randomized clinical trial of bowel preparation with a single phosphate enema or polyethylene glycol before elective colorectal surgery. Br J Surg, 2006, 93:427–433.
26. Platell C, Barwood N, Dorfmann G, Makin G. The incidence of anastomotic leaks in patients undergoing colorectal surgery. Colorectal Dis, 2007, 9:71–79.


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