The Prophylactic use of Anti-Microbial Agents in the Surgery of the Intestine

Summary

The purpose of bowel preparation before surgery is first defined. In order to achieve the objectives of avoiding both tissue sepsis as a result of bacterial invasion from the intestine and interference with healing processes as a result of anti-bacterial therapy it is necessary to reduce the bacterial content of the intestine, and contamination of tissues, without damaging the defence mechanisms of the body.

Mechanical cleansing of the intestine is the first essential process, but may not be possible where partial or complete obstruction is present. Cleansing can be carried out both by reducing the residue of the diet and by washing out the contents of the intestine. Having achieved mechanical cleansing the merits and drawbacks of various anti-bacterial agents are then discussed, both in relation to pre-operative administration of drugs, active within the alimentary canal, and the prophylactic use of antibiotic powders and solutions at the time of operation. Finally, the systemic administration of antibiotics as a prophylactic measure after surgery is discussed.

It is emphasised that surgical technique is of fundamental importance in the prevention of subsequent infective complications.