Comparison between oral antibiotics and probiotics as bowel preparation for elective colon cancer surgery to prevent infection: prospective randomized trial

Surgery. 2014 Mar;155(3):493-503. doi: 10.1016/j.surg.2013.06.002.


Background: We have already reported that, for patients undergoing elective colon cancer operations, perioperative infection can be prevented by a single intravenous dose of an antibiotic given immediately beforehand if mechanical bowel preparation and the administration of oral antibiotics are implemented. Synbiotics has been reported to reduce the rate of infection in patients after pancreatic cancer operations. The effectiveness of oral antibiotics and probiotics in preventing postoperative infection in elective colon cancer procedures was examined in a randomized controlled trial.

Methods: Three hundred ten patients with colon cancer randomly were assigned to one of three groups. All patients underwent mechanical bowel preparation and received a single intravenous dose of flomoxef immediately before operation. Probiotics were administered in Group A; oral antibiotics were administered in Group B; and neither probiotics nor oral antibiotics were administered in Group C. Stool samples were collected 9 and 2 days before and 7 and 14 days after the procedure. Clostridium difficile toxin and the number of bacteria in the intestine were determined.

Results: The rates of incisional surgical-site infection were 18.0%, 6.1%, and 17.9% in Groups A, B, and C, and the rates of leakage were 12.0%, 1.0%, and 7.4% in Groups A, B, and C, respectively, indicating that both rates were lesser in Group B than in Groups A and C (P = .014 and P = .004, respectively). The detection rates of C. difficile toxin were not changed among the three groups.

Conclusion: We recommend oral antibiotics, rather than probiotics, as bowel preparation for elective colon cancer procedures to prevent surgical-site infections.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Administration, Oral
  • Adult
  • Aged
  • Aged, 80 and over
  • Anastomotic Leak / epidemiology
  • Anastomotic Leak / prevention & control
  • Anti-Bacterial Agents / therapeutic use*
  • Cathartics / therapeutic use
  • Cephalosporins / therapeutic use
  • Colectomy*
  • Colonic Neoplasms / surgery*
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Elective Surgical Procedures*
  • Feces / microbiology
  • Female
  • Humans
  • Injections, Intravenous
  • Kanamycin / therapeutic use
  • Male
  • Metronidazole / therapeutic use
  • Middle Aged
  • Preoperative Care / methods*
  • Probiotics / therapeutic use*
  • Prospective Studies
  • Surgical Wound Infection / epidemiology
  • Surgical Wound Infection / prevention & control*
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Cathartics
  • Cephalosporins
  • Metronidazole
  • Kanamycin
  • flomoxef