Prophylaxis in colonic surgery

The place of metronidazole in preventing and treating anaerobic infections after colonic surgery is considered in the light of results from three trials of the drug, carried out at the Luton and Dunstable Hospital, involving successively gynaecological, appendkrular and colonic operations. The colonic study was a double-blind trial among 46 patients undergoing elective colonic surgery. Anaerobic infections did not develop in any of 27 metronidazole-treated patients, but did develop in 11 (58%) of 19 controls who received placebo. Infected control patients were subsequently successfully treated with metronidazole. Metronidazole prophylaxis greatly improves the prognosis of patients with faecal soiling of the peritoneal cavity. Moreover, in these patients it makes possible not only earlier and bolder surgery, but also delay in surgical intervention when appropriate.