Oral Antibiotics for Colon SurgeryThe Questions Remain the Same, as Do the Answers

摘要

Nichols et al~(1) first demonstrated the effectiveness of adding oral antibiotics to mechanical bowel preparation in 1973, yet in this issue of JAMA Surgery , Vo and colleagues~(2) are publishing a retrospective analysis demonstrating the efficacy of oral antibiotics in reducing superficial and deep space infections in left colon resections in 2017. Oral antibiotics are inexpensive and generally well tolerated. So why are we still addressing the issue? First, virtually all patients, at least in the United States, now receive appropriate prophylactic parenteral antibiotics in a timely fashion, something not necessarily true in 1973. Second, mechanical bowel preparation has evolved, including the use of isotonic polyethylene glycol preparations, and is even skipped completely by some surgeons. Third, minimally invasive procedures have reduced the number of wound infections. Fourth, an increasing understanding of the beneficial as well as deleterious effects of the colonic microbiome suggests that disrupting the colonic microbial ecology may have adverse effects ranging from the obvious, such as Clostridium difficile infection, to the less obvious, such as adverse effects with regard to anastomotic healing,~(3) and crosstalk between the microbial community within the intestine and the host’s immune system that in turn mediates host immune responses.~(4)