| Abstrakt: |
Without prophylaxis, the rate of infectious complications in gastrointestinal surgery varies, both with the indication and the procedure. The main determinant for infection is endogenous bacterial contamination of incised tissues. Anaerobes dominate the normal flora of the distal parts of the bowel and increase significantly in a number of conditions requiring surgical treatment. Among anaerobes, Bacteroides fragilis is the principal pathogen following surgery for cancer, inflammatory bowel disease, and appendicitis. Thus activity against Bact fragilis is needed for surgical prophylaxis in these instances. As the effective period of prevention is restricted, the timing of administration of a prophylactic agent is crucial.In gastrointestinal surgery an appropriate agent, based on its antibacterial spectrum and pharmacokinetic properties, should be administered to provide effective serum and tissue concentrations during surgery. Both the incidence and severity of infectious complications and mortality could then be reduced. As not only microbial but also treatment and patient-related factors influence tissue healing, comparisons between different trials are difficult to evaluate.Though many forms of gastrointestinal surgery require only prophylactic coverage against aerobes or no prophylaxis at all, activity against anaerobes, especially Bact fragilis, is essential in those instances where post-operative infections are mixed or purely anaerobic. For prophylaxis in gastrointestinal surgery, the antibacterial spectrum of nitroimidazoles limits its use to locations where anaerobes normally constitute a dominant part of the normal flora or where conditions favour an increase in anaerobes.In situations where mixed infections frequently develop after surgery, the choice of antimicrobial agents for prophylaxis should consist of a combination of an anti-anaerobic agent such as tinidazole with an anti-aerobic agent of similar pharmacokinetic properties. [ABSTRACT FROM PUBLISHER] |
