| Year |
Practice recommendations |
Landmark developments |
| 1984a |
• No popular standard guidelines in place
• Oral antibiotics for use alongside mechanical bowel preparation – Neomycin plus erythromycin base
• IV drugs – cefoxitin, clindamycin, gentamicin or tobramycin
• Optional – metronidazole
|
• Role of metronidazole recognized, though controversial
• Choice of usable drugs dependent on site of the operation and the most probable contaminants encountered.
• Possible adverse reactions:
– suppression of the normal microbial flora
– superinfection by drug-resistant microorganisms
– continued infection with the initial pathogen through the emergence of drug-resistant mutants.
|
| 1993 [11] |
• Drugs for administration:
– Neomycin and Erythromycin (oral), or
– Gentamicin (1.5 mg/kg) plus metronidazole (500mg), or
– Clindamicin (300 mg), or
– Cefixitin (2 g IV), or
– Cefotatan (2 g IV)
• Timing – parenteral initial dose immediately before the operation. Second dose short half-life drugs
• Route – IV is optimal for adequate tissue levels; oral drugs are an alternative
• Duration – single dose sufficient
• Choice – effective against pathogens most frequently responsible for SSIs
• Side effects – Rare; main ones are allergic reactions and antibiotic-associated colitis.
|
• Specific recommendations made; initiation of formal practice guidelines
• The significance of preoperative initial dosing was recognised; the hallmark of prophylaxis
• Oral drugs described as alternatives to the ldeal IV route of administration
• Multiple dosing not essential; a single dose is adequate
|
| 1999 [31] |
• Drugs for administration:
– Neomycin and Erythromycin (oral), or
– Gentamicin (1.5 mg/kg) plus metronidazole (500mg), or
– Clindamicin (300 mg), or
– Cefixitin (2 g IV), or
– Cefotatan (2 g IV)
• Timing – parenteral initial dose immediately before the operation. Second dose short half-life drugs
• Route – IV is optimal for adequate tissue levels; oral drugs are an alternative
• Duration – single dose sufficient
• Choice – effective against pathogens most frequently responsible for SSIs
Side effects – Rare; main ones are allergic reactions and antibiotic-associated colitis. |
• IV and oral combination is recommended as a preserve of colorectal (high-risk) surgery
• Preoperative oral drugs are given way ahead of the time of surgery
• A maximum duration of prophylaxis of 24 hours identified
• The role of MBP in colorectal surgery made clear
• Role of re-dosing described
|
| 2013 [11] |
• Drugs for administration:
– Neomycin sulphate 1 g plus erythromycin base 1 g p.o. (after MBP is completed) at 19, 18, and 9 hr before surgery
if oral route is contraindicated,
– cefoxitin, cefotetan, or cefmetazole 2 g IV, at induction of anesthesia
for patients undergoing colorectal resection
– oral neomycin and erythromycin plus an IV cephalosporin
|
• First line and second line alternatives identified
• Broader range of drugs identified
• The significance of body weight introduced – weight-based dosing
• More alternatives available in case of β-lactam allergy
• Remedies for MRSA colonisation introduced
|