Colectomy, mucosal proctectomy, and ileal pouch-anal anastomosis. A prospective trial of optimal antibiotic management

Ann Surg. 1991 Mar;213(3):242-7. doi: 10.1097/00000658-199103000-00011.


The ideal prophylactic antibiotic regimen has not been established for patients undergoing colectomy, mucosal proctectomy, and endorectal ileoanal anastomosis, a prolonged operation frequently accompanied by abdominal and pelvic contamination and associated with an infection rate up to 20%. The aim of this study was to evaluate, in a prospective, randomized, double-blind fashion, the efficacy of a short perioperative course compared to an extended postoperative course of intravenous antibiotics (cefoxitin) in patients undergoing colectomy with ileoanal anastomosis. Forty patients with ulcerative colitis or familial polyposis coli received a mechanical and oral antibiotic bowel preparation and a standard three-dose perioperative course of intravenous cefoxitin. Patients then were randomized to receive intravenous cefoxitin, 1 g every 6 hours, or placebo for 5 days. No differences in overall postoperative morbidity were observed and neither group developed intra-abdominal, pelvic, or wound infections. It is concluded that a standard three-dose perioperative course of intravenous antibiotics provides adequate prophylaxis in the prevention of infectious complications in patients undergoing colectomy, mucosal proctectomy, and ileoanal anastomosis.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenomatous Polyposis Coli / surgery
  • Administration, Oral
  • Adult
  • Anal Canal / surgery*
  • Anastomosis, Surgical
  • Cefoxitin / administration & dosage
  • Cefoxitin / therapeutic use
  • Colectomy*
  • Colitis, Ulcerative / surgery
  • Double-Blind Method
  • Drug Therapy, Combination / administration & dosage*
  • Erythromycin / administration & dosage
  • Erythromycin / therapeutic use
  • Female
  • Gardner Syndrome / surgery
  • Humans
  • Ileum / surgery*
  • Infection Control
  • Infusions, Intravenous
  • Male
  • Neomycin / administration & dosage
  • Neomycin / therapeutic use
  • Postoperative Care
  • Postoperative Complications / prevention & control
  • Premedication
  • Prospective Studies
  • Rectum / surgery*


  • Erythromycin
  • Cefoxitin
  • Neomycin