• Annals of surgery · Jun 2016

    Randomized Controlled Trial Multicenter Study Comparative Study

    Oral and Parenteral Versus Parenteral Antibiotic Prophylaxis in Elective Laparoscopic Colorectal Surgery (JMTO PREV 07-01): A Phase 3, Multicenter, Open-label, Randomized Trial.

    • Hiroaki Hata, Takashi Yamaguchi, Suguru Hasegawa, Akinari Nomura, Koya Hida, Ryuta Nishitai, Satoshi Yamanokuchi, Takeharu Yamanaka, and Yoshiharu Sakai.
    • *Department of Surgery, National Hospital Organization, Kyoto Medical Centre, Kyoto, Japan†Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan‡Department of Surgery, Faculty of Medicine, Saga University, Saga, Japan§Department of Surgery, Digestive Disease Centre, Kyoto Katsura Hospital, Kyoto, Japan¶Department of Surgery, Osaka Red Cross Hospital, Osaka, Japan||Department of Biostatistics and Epidemiology, Graduate school of Medicine, Yokohama City University, Yokohama, Japan.
    • Ann. Surg. 2016 Jun 1; 263 (6): 1085-91.

    ObjectiveTo confirm the efficacy of oral and parenteral antibiotic prophylaxis (ABX) in the elective laparoscopic colorectal surgery.BackgroundThere is no evidence for the establishment of an optimal ABX regimen for laparoscopic colorectal surgery, which has become an important choice for the colorectal cancer patients.MethodsThe colorectal cancer patients scheduled to undergo laparoscopic surgery were eligible for this multicenter, open-label, randomized trial. They were randomized to receive either oral and parenteral prophylaxis (1 g cefmetazole before and every 3 h during the surgery plus 1 g oral kanamycin and 750 mg metronidazole twice on the day before the surgery; Oral-IV group) or parenteral prophylaxis alone (the same IV regimen; IV group). The primary endpoint was the incidence of surgical site infections (SSIs). Secondary endpoints were the incidence rates of Clostridium difficile colitis, other infections, and postoperative noninfectious complications, as well as the frequency of isolating specific organisms.ResultsBetween November 2007 and December 2012, 579 patients (289 in the Oral-IV group and 290 in IV group) were evaluated for this study. The incidence of SSIs was 7.26% (21/289) in the Oral-IV group and 12.8% (37/290) in the IV group with an odds ratio of 0.536 (95% CI, 0.305-0.940; P = 0.028). The 2 groups had similar incidence rates of C difficile colitis (1/289 vs 3/290), other infections (6/289 vs 5/290), and postoperative noninfectious complications (11/289 vs 12/290).ConclusionsOur oral-parenteral ABX regimen significantly reduced the risk of SSIs following elective laparoscopic colorectal surgery.

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