A patient with a non obstructing carcinoma of the sigmoid colon is being prepared for elective resection. To minimize the risk of postoperative infectious complications, your planning should include
|A||A single preoperative parenteral dose of antibiotic effective against aerobes and anaerobes.|
|B||Avoidance of oral antibiotics to prevent emergence of clostridium difficile|
|C||Postoperative administration for 2 to 4 days of parenteral antibiotics effective against aerobes and anaerobes|
|D||Postoperative administration for 5 to 7 days of parenteral antibiotics effective against aerobes and anaerobes|
( REF. SABISTON SURGERY 18TH EDN CHP 47 PG 2657)
a. Elective colorectal cases are classified as clean-contaminated and, as such, benefit from routine single-dose administration of parenteral antibiotics 30 minutes before incision.
b. There is evidence to show that when operative times are prolonged, additional doses at 4-hour intervals reduce wound infection.
c. When the operation is completed, postoperative administration of antibiotics for a clean-contaminated case such as a routine segmental resection does not further reduce infectious complications and may promote Clostridium difficile colitis, Candida infection, and the emergence of bacterial antibiotic resistance.
d. Antibiotics active against both aerobes and anaerobes are ideal: second- or third-generation cephalosporins alone, or combination of a fluoroquinolone plus metronidazole or clindamycin is typical. The use of additional oral antibiotics to theoretically further reduce the bacterial load is widely accepted, but not as well validated.
e. A preparation often used consists of erythromycin base (1 g) and neomycin (1 g) given in three preoperative doses the day before surgery. However, this regimen is associated with a high incidence of nausea and abdominal cramps, and some surgeons prefer to prescribe oral ciprofloxacin or metronidazole.