Single dose pre-operative antimicrobial prophylaxis in abdominal operations

Infectious problems in elective surgery of the alimentary tract: the influence of pre-operative factors. The Norwegian Gastro-Intestinal Group (NORGAS)

The influence of some pre-operative factors on infectious complications after elective abdominal surgery was investigated in a prospective multi-centre study of 1537 patients in surgical departments regularly using a standardized prophylactic antibiotic regimen. A total of 1101 patients received 1600 mg tinidazole plus 400 mg doxycycline intravenously 1-hour pre-operatively. Analysis of the results showed that increasing age, malignancy, risk factors noted by the surgeon before the surgical procedure, and discrepancies between assumed disease and peri-operative findings were associated with significantly more post-operative complications, but not more infectious complications related to peri-operative contamination. Pre-operative hospital stay did not influence the infection rate provided that prophylaxis was given.

Infectious problems after elective surgery of the alimentary tract: the influence of peri-operative factors. The Norwegian Gastro-Intestinal Group (NORGAS)

A prospective multi-centre study was carried out on 1537 patients to investigate the influence of some peri-operative factors on the infectious complications after elective abdominal surgery in surgical departments where a standardized prophylactic antibiotic regimen is used regularly. The antibiotic regimen consisted of 1600 mg tinidazole and 400 mg doxycycline given intravenously 1-hour preoperatively. The results showed that total gastrectomy seemed to give higher infection rates than other gastroduodenal procedures. Low anterior and abdomino-perineal rectal resections were followed by more infectious complications than colonic resections, but this difference was significant only due to the perineal wound infections and failures of the low anterior anastomosis. Prolonged operation time was followed by increased number of infectious complications only when prophylaxis was not given. Blood transfusions led to a highly significant increase in infectious complications. Peri-operative surgical complications, splenectomy and stoma formation did not influence post-operative infectious complications.

Infectious problems in elective non-colorectal abdominal surgery. The Norwegian Gastro-Intestinal Group (NORGAS)

The incidence of post-operative infectious complications after high-risk biliary and gastroduodenal and all cases of small bowel surgery was investigated in 965 patients included in a prospective multi-centre study. Selected types of operation where antibiotic prophylaxis was considered beneficial were defined and patients in these categories were to receive a standardized prophylactic regimen of 400 mg doxycycline plus 1600 mg tinidazole intravenously 1-hour pre-operatively or at induction of anaesthesia. Of the 965 patients, 408 did not receive prophylaxis, 547 received the standard regimen and 10 were given a different prophylaxis. The overall compliance rate with the protocol was 89%. Analysis of the results of clinical evaluation of the patients 3, 7 and 15 days after surgery showed that only 21 (2.1%) of the 965 patients had developed surgical infectious complications. Two (0.2%) patients died of septic complications. No serious side-effects of the prophylactic regimen were recorded.

Critical care requirements after elective surgery of the alimentary tract. The Norwegian Gastro-Intestinal Group (NORGAS)

Serious post-operative infectious complications requiring intensive care treatment were seen regularly in patients undergoing major abdominal surgery before peri-operative antimicrobial prophylaxis was introduced. A prospective multicentre study was carried out to study intensive care requirements in patients undergoing elective surgery of the alimentary tract in hospitals using a standardized antimicrobial prophylaxis regimen of a single intravenous dose of 400 mg doxycycline plus 1600 mg tinidazole 1-hour pre-operatively or at induction of anaesthesia. Only 56 (3.6%) out of the 1537 patients included in the study were treated in an intensive care unit for more than 1 day. Post-operative infectious complications related to peri-operative endogenous contamination were the reason for intensive care treatment in only 4 (0.26%) patients. It is concluded that such infectious complications are no longer the major reason for intensive care treatment after elective gastro-intestinal surgery and the substantial reduction in their frequency has been due to the use of 'short-term barrier' antimicrobial prophylaxis.

Tinidazole--microbiology, pharmacology and efficacy in anaerobic infections

Tinidazole is a 5-nitroimidazole with selective activity against anaerobic bacteria and protozoa. It is bactericidal at low concentrations and its spectrum covers most anaerobic bacteria and some capnophilic microorganisms. Anaerobic bacteria known to be resistant to tinidazole include anaerobic streptococci, actinomyces and propionibacteria. Tinidazole is one of the most active antibacterial agents against Bacteroides fragilis which is one of the most resistant species of anaerobic bacteria. Only a few strains have been reported to be resistant. Tinidazole has been shown to be efficacious in protozoal infections such as trichomonal vaginitis, amoebiasis and giardiasis. Clinical studies have also shown that tinidazole is efficacious in the treatment of anaerobic infections including respiratory tract infections, intra-abdominal sepsis and obstetrical and gynecological infections. Since tinidazole has no activity against aerobic bacteria, it must be combined with other antibacterial agents in the treatment of mixed infections involving aerobic and anaerobic bacteria. Tinidazole has also been used successfully alone or in combination with other antimicrobial agents for prophylaxis in patients undergoing elective colonic and abdominal surgery, emergency appendectomy and gynecological surgery.